Manufacturer Essential Pharma announced last month that it would be discontinuing its Priadel 200mg and 400mg modified-release tablets from April 2021 after taking the “difficult decision” that the manufacture and supply of the drugs is “no longer viable”.

While the Department of Health and Social Care (DH) lists Camcolit 400mg as another option for lithium carbonate 400mg modified-release tablets, there is no alternative available for lithium carbonate 200mg modified-release tablets, the Pharmaceutical Services Negotiating Committee (PSNC) said in an update to contractors last week (September 4).

The negotiator has now warned pharmacies not to dispense the more expensive Camcolit brand against a generic prescription for lithium carbonate 400mg.

“Due to the narrow therapeutic index of lithium and the variation in bioavailability between different lithium preparations, pharmacy teams should expect prescriptions to specify the brand of lithium required”, PSNC said.

“Where pharmacy teams receive a generically written prescription for lithium carbonate 400mg modified-release tablets and the Camcolit brand is required for the patient, pharmacy teams are advised to refer the prescription back to the prescriber to be written for the brand,” the negotiator added.  

Price disparity

The September drug tariff lists the price for lithium carbonate 400mg modified-release tablets as £4.02 for a pack of 100, based on Priadel. Meanwhile, the Camcolit brand price is listed as £48.18 for a pack of 100 in the Dictionary of Medicines and Devices, PSNC said in the update.

The negotiator stressed that where pharmacies receive a generically written prescription for 100 lithium carbonate 400mg modified-release tablets, they will only be reimbursed the £4.02 drug tariff price – which is £44.16 lower than the Camcolit price.

If the Camcolit brand is required for the patient, pharmacies therefore need to “refer the prescription back to the prescriber to be written for the brand”, PSNC said.

“PSNC is keen to ensure that the discontinuation of Priadel doesn't adversely affect reimbursement for Lithium carbonate 400mg modified-release tablets,” PSNC drug tariff and reimbursement manager Suraj Shah told C+D earlier this week (September 7).

“As supplies run down, there will soon be a time when contractors can only obtain the more expensive Camcolit brand,” Mr Shah said.

“With Priadel stock expected to be exhausted by April 2021, we will work with [the DH] to update the drug tariff accordingly. In the meantime, contractors will need to ask prescribers to write prescriptions specifying the brand required as per clinical guidance," he added.