[Preference policy for levothyroxine: switch between brands may lead to symptoms and extra costs]

A considerable percentage of the Dutch population has primary hypothyroidism and is therefore lifelong treated with levothyroxine. Recently, Dutch healthcare insurance companies made plans to change their reimbursement policies with regard to levothyroxine. This policy change implies that the healthcare insurer will only reimburse one specific brand of levothyroxine usually the most inexpensive brand with the aim of reducing healthcare costs. The more expensive brands will no longer be reimbursed, forcing patients to switch between brands. However, clinical experience and previous research reveal that substitution between levothyroxine brands can lead to symptoms both with and without changes of serum thyroxine levels. Do the advantages of levothyroxine substitution even outweigh the disadvantages?