How could Brexit impact your thyroid health management
Prepare for possible changes in access to thyroid medication and healthcare
Brexit could change some healthcare processes — for people living in or visiting the UK, as well as UK citizens abroad. A lot has been written about the possible lack of medication supply. Having an underactive thyroid and Hashimoto’s usually means you need to be on a lifelong support of thyroid hormones in the form of a pill. You also need to do regular medical checkups which include testing blood hormone levels.
The World Health Organization (WHO) has predicted different impacts for four Brexit scenarios:
No-deal (no formal agreement on terms of withdrawal)
A withdrawal agreement (with a transition period until December 2020)
The Northern Ireland backstop
The political declaration of the future relationship between the European Union (EU) and the UK
A no-deal Brexit is the worst option for hypothyroid patients, as all the legal relationships with the EU will be severed which would severely impact the availability of certain medication brands (1, 2). There might be a lack of medical staff too (3), meaning you might need to wait longer to get your lab tests or to visit your doctor/thyroid specialist.
A no-deal Brexit will immediately terminate all of EU cross-border healthcare rights.
What does that mean? If you’re an EU citizen living in the UK or a UK citizen living in the EU, your health insurance will be impacted (possibly becoming invalid). Unfortunately looking for a new insurance as a patient with a chronic condition like Hashimoto’s or an underactive thyroid could mean facing very expensive health insurance (4, 5).
If you’re an EU national living in the UK, you’ll need to get a residency permit before you can get access to the UK’s National Health Service (NHS) (6).
If there is a withdrawal agreement, there will be a continuation of reciprocal healthcare.
What does that mean? If you’re a UK citizen living abroad in the EU, or an EU citizen living in the UK, you should be entitled to use your European Health Insurance Card (EHIC) to access cross-border healthcare until the end of 2020 (5, 6).
In case of a Northern Ireland backstop, all relevant medication produced in Northern Ireland will be transported to the EU, as Northern Ireland will still be considered part of the EU. It remains unclear if medication produced in Northern Ireland could be sent to the UK, as UK medication licences would no longer be recognized across the EU/UK borders.
What does that mean? Unless the UK applies for processes such as medication harmonisation and licensing, it will not be able to import or export medication to the rest of the EU. This could cause medication shortages in the UK. Also, the UK will be put low on the medicine shortage priority list (7).
If you’re using thyroid medication produced within the EU, but outside of the UK, your doctor or specialist might prescribe you the “best alternative medication” (8). A similar process will likely happen to people living in the EU using UK-produced medications.
What does that mean? You might be forced to switch brands of your thyroid medication.
The UK will also become a less attractive place to launch new medications by global pharma, and such launches might be delayed by up to two years (9, 10).
What does that mean? People living in the UK will experience delays in the availability of the new medications.
List of generic thyroid hormone replacement medications produced in the EU (not the UK):
Eltroxin — Mercury/FAMAR
Levothyroxine — Mercury/FAMAR
Levothyroxine — Colonis
L-thyroxin — Aliud
L-thyroxin- Henning/ Sanofi-Aventis
Levothyroxine — Tirosint
Liothyronine — Teva/Teva Gyogyszergyar Zrt
Thybon — Henning/ Sanofi-Aventis
Slow release T3 — Receptura Pharmaproduktion GmbH
Novothyral and Euthyrox — Merck
List of generic thyroid hormone replacement medications produced in the UK:
Eltroxin — Concordia
Levothyroxine — Concordia
Levothyroxone — Actavis
Levothyroxone — Almus
Levothyroxone — Wockhardt
Whatever type of Brexit happens, the UK’s Department of Health and Social Care (DHSC) promised to ensure the medication produced outside of the UK can reach hospitals and pharmacies in between 24 hours to 72 hours. To coordinate the shipments, the department has set up a logistics hub in Belgium — expected to move products from mainland Europe into the UK and to the patients within three days of their arrival into the hub. However, this plan may not be applicable to each medication brand. Talk to your healthcare provider about medication availabilities.
If you are visiting UK
Make sure to bring enough of your thyroid medications. If you use natural thyroid preparations, check if you’re allowed to bring them into the country. The issue with the natural dessicated thyroid preparation is the animal origin of the pill.
Always have pills in the original packages, and preferably with explanations in English (this will likely not be needed, but it is good to be prepared).
Moving to or from the UK
Check here if your specific medication is on the list of medications with prescriptions in an EU country. There is a chance your doctor will want to switch you from one brand to another.
If you’re in the middle of medical treatment during a no-deal Brexit
It’s unclear what will happen to your insurance coverage under this circumstance. Check with your doctor what changes could happen in your coverage on the day of and post Brexit if you need to undergo thyroid surgery, assisted reproduction (IVF), or any other medical procedure. Try to schedule your procedures to be completed a few months or weeks before or after Brexit to give yourself a good buffer.
The NHS european office has more helpful resources with detailed information.
Fahy N, et al. How will Brexit affect health and health services in the UK? Evaluating three possible scenarios, 2017
European Commission. Preparedness notices, 2019
Nuffield Trust, The Health Foundation, The King’s Fund. The health care workforce in England: make or break, 2018
UK Government. UK residents visiting the EU/EEA and Switzerland: Healthcare, 2019
McKee D, et al. What might Brexit mean for British tourists travelling to the rest of Europe, 2018
UK Government. The UK’s future skills-based immigration system, 2018
Flear M. Charting a roadmap towards membership and formal voice in global bioethics standard-setting: health research and the case of the International Council on Harmonisation, 2018
Department of Health and Social Care. Policy paper: getting medication, 2019
Kazzazi F, et al. Evaluating the impact of Brexit on the pharmaceutical industry, 2017
Business Energy and Industrial Strategy Committee. The impact of Brexit on the pharmaceutical sector, 2018