Effects of restricting levothyroxine dosage strength availability

Area of Science:

• Pharmacoeconomics
• Clinical Pharmacy
• Endocrinology

Background:

• Hospital formularies often restrict medication options to control costs.
• Levothyroxine is a common medication for thyroid disorders, with various available dosage strengths.
• The impact of restricting levothyroxine dosage strengths on clinical outcomes and pharmacy costs requires investigation.

Purpose of the Study:

• To evaluate the effect of restricting levothyroxine dosage strengths on physicians' management of patients.
• To determine if hospital formulary restrictions on levothyroxine lead to pharmacy cost savings.
• To assess the impact on therapeutic outcomes and dosing complexity.

Main Methods:

• A prospective, randomized, controlled trial was conducted.
• Thirty-three endocrinologists were randomized to prescribe levothyroxine from restrictive or nonrestrictive formularies.
• Outcomes included laboratory results, thyroid function tests, clinic visits, compliance, drug costs, and inventory costs for 241 outpatients.

Main Results:

• Restricting levothyroxine dosage strengths did not significantly alter therapeutic outcomes.
• The restricted formulary led to more complex dosing regimens.
• No significant cost savings were observed with the restricted formulary.

Conclusions:

• Hospital formulary restrictions on levothyroxine dosage strengths do not appear to improve patient management or provide cost savings.
• Restricted formularies may increase dosing complexity without clear financial benefits.
• Further research is needed to confirm cost-containment measures before widespread implementation, especially concerning non-specialist care.