Hydrocortisone was hardly a medical breakthrough. The tablets had been used in Britain since 1955.
In April 2008, a pack of the 10mg version cost the NHS 70p. By March 2016 it was £88. The 20mg tablets rose from £1.07 to £102.74.
Auden Mckenzie had bought the licences and dropped the Hydrocortone brand. It relaunched the medicine as a generic, starting at about £4 a pack.
That mattered. Branded medicines were subject to price controls. Generics were not, on the assumption that rival suppliers would compete for NHS business and hold prices down.
But when two possible rivals prepared to enter the market, Auden paid them.
Waymade received £1.8 million and AMCo £21 million under agreements that kept their own tablets off the shelves. Those were the CMA’s findings, now upheld in court. Actavis UK took over the business in 2015 and kept paying AMCo.
Meanwhile, the price climbed.
People with adrenal insufficiency depend on hydrocortisone because their bodies do not make enough cortisol. Addison’s disease is one of the conditions treated with it. Going without the medicine can be fatal.
The NHS spent roughly £500,000 on hydrocortisone tablets in 2007. In 2016, it spent more than £80 million.
The CMA imposed fines in 2021 after finding excessive pricing and unlawful agreements to delay competition. The companies fought the decision through the courts.
They have now lost on the central issue. Lord Justice Zacaroli said their arguments did not “get near” overturning the findings.
There is still an argument over the fines. They were originally set at £266.5 million and now stand at about £240 million after an earlier reduction. The Court of Appeal has sent the remaining penalty arguments back to the Competition Appeal Tribunal because it did not deal with them properly the first time.
It did not overturn the findings against the companies.