Court upholds CMA’s £99m fine on pharma over excessive NHS thyroid drug prices
Source: gov.uk (2025-05-07)

The Court of Appeal has unanimously upheld the CMA’s finding that Advanz broke the law by overcharging the NHS for essential thyroid drug liothyronine.

- CMA secures important win in the Court of Appeal after Advanz and Cinven sought to appeal
- Court of Appeal also reinstated the CMA’s original fine of £51.9 million on Cinven after the CAT reduced the figure to £37.1 million in 2023
- Total amount in fines stands at £99 million, divided amongst Advanz’s owners across the infringement period: £6.2m for HgCapital; £51.9m for Cinven; and £40.9m for Advanz
In a unanimous judgment, the Court of Appeal has confirmed the Competition and Markets Authority’s (CMA) finding of excessive and unfair pricing in the supply of liothyronine tablets in the UK; and has reinstated the full penalty of £51.9 million imposed by the CMA on private equity firm Cinven.

Liothyronine is an essential medicine used to treat thyroid hormone deficiency. In 2006, the total NHS annual spend on the tablets was £600,000. Between 2009 and 2017, Advanz, the sole supplier of liothyronine tablets in the UK, increased the price it charged from £20 to £248 per box – an increase of over 1,110%. As a result, NHS annual spending on liothyronine jumped from over £2.3 million in 2009 to more than £30 million by 2016.

After an extensive investigation, in July 2021, the CMA found that Advanz had broken the law by this level of pricing to the NHS, without justification: the cost of producing the tablets did not increase significantly; and there was no evidence of meaningful innovation or investment by the supplier. The CMA fined Advanz Pharma (the current owner of the Advanz business) together with two former owners (HgCapital and Cinven) for their part in the infringement over their ownership periods.

All three companies originally appealed the CMA’s decision before the Competition Appeal Tribunal (CAT). In August 2023, the CAT fully upheld the CMA’s findings, but reduced the penalties imposed on HgCapital and Cinven.

HgCapital decided not to pursue its appeal further, instead agreeing with the CMA to pay its fine of £6.2 million. Advanz and Cinven both sought permission to appeal the CAT’s decision to the Court of Appeal and the CMA, in turn, sought to overturn the CAT’s reduction in Cinven’s penalty.

Following a 3-day hearing in December 2024, the Court of Appeal unanimously refused Advanz Pharma and Cinven permission to appeal the CAT judgment, ruling that they had no arguable basis upon which to challenge the CAT’s decision to uphold the CMA’s findings.

The Court of Appeal also agreed that the CMA’s original penalty for Cinven was appropriate and reinstated it in full to £51.9 million.

Sarah Cardell, Chief Executive of the CMA, said:

This is another resounding win for the CMA in this case – and a vote of confidence for the work we do to protect consumers and tackle illegal behaviour.

Prices charged to the NHS, and ultimately taxpayers, must be fair. We will continue to stand up for patients and take action against companies that abuse their market power, thereby harming consumers and the wider economy.

For more information on the CMA’s investigation, visit the Liothyronine tablets: suspected excessive and unfair pricing case page (https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.gov.uk%2Fcma-cases%2Fpharmaceutical-sector-anti-competitive-conduct&data=05%7C02%7CLucy.Knowles%40cma.gov.uk%7Cc63b196f6be547fd9de108dd8e22a465%7C1948f2d40bc24c5e8c34caac9d736834%7C1%7C0%7C638823001647586380%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=5sZPqE6mj5Ilcut%2BG34WRfJy0sA11W2%2FyhkgwBUR03Y%3D&reserved=0).

Notes for editors:
- For media queries, please contact the press office on xxx@xxx.xx or on xx-xxxx-xxxx.
- Advanz Pharma and Cinven both appealed against the CAT’s judgment. The CMA cross-appealed against the CAT’s reduction of Cinven’s penalty from £51.9 million to £37.1 million.
- HgCapital did not appeal the CAT’s judgment.
- A three-day hearing took place in December 2024 to hear all parties’ appeals. The Court of Appeal had adjourned all applications for permission to appeal the CAT’s judgment into a ’rolled-up’ hearing of both those applications for permission and the substantive appeals.
- Fludrocortisone (https://www.gov.uk/government/news/cma-levies-fines-of-23m-and-secures-8m-for-nhs-in-pharma-probe) (2019): £2.3 million in fines and £8 million redress to the NHS for market-sharing.
- Nortriptyline (https://www.gov.uk/government/news/over-3m-in-fines-and-1m-for-nhs-in-cma-pharma-probe) (2020): £3.4 million in fines and £1 million redress to the NHS for illegal arrangements including market-sharing and information exchange.
- Paroxetine (https://www.gov.uk/government/news/cat-upholds-infringement-decision-for-pay-for-delay-pharma-deals) (2021): £27.1 million in fines for anti-competitive agreements and abuse of dominance.
- Hydrocortisone (https://www.gov.uk/government/news/cma-finds-drug-companies-overcharged-nhs) (2021): £260 million in fines for excessive and unfair pricing and market sharing (currently under appeal).