Hydrocortisone tablet prices vary, and some strengths cost much more than others. Lower doses can be very helpful for those who are steroid-dependent and have issues splitting tablets, however they cost far more than 10mg doses.

In this article, we explain why the cost of lower-dose tablets matters for the NHS, how you can talk to your GP if splitting tablets is difficult (lower doses or requesting a specific brand), and what to do if your hydrocortisone tablets are crumbling.

This includes a statement from Accord-UK Ltd on the current known quality issue with their hydrocortisone 10mg tablets. To support you in obtaining suitable alternatives, we have a one-page document that people with adrenal insufficiency can take to their GP or healthcare professional to explain this issue and discuss alternative options.

• How are medicine prices worked out?
• Why lower-dose hydrocortisone tablets cost more
• When lower-dose tablets are needed
• Reporting problems with splitting tablets
• Statement from Accord & next steps if you are affected
• Talking to your GP
• Summary

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How are medicine prices worked out?

There are two main sources used to look up medicine prices:

• The Drug Tariff: shows how much pharmacies are reimbursed by the NHS for supplying a medicine.
• The British National Formulary (BNF): shows the list prices pharmacies may actually pay to buy medicines from manufacturers and wholesalers.

The Drug Tariff does not always reflect real-world costs. When there are medicine shortages, pharmacies may be forced to buy more expensive brands but still only receive the lower Drug Tariff reimbursement. This can mean pharmacies are supplying essential medicines at a financial loss.

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Why lower-dose hydrocortisone tablets cost more

At the time of writing this article, the following Drug Tariff prices show:

• Hydrocortisone 2.5mg tablets: £35.56
• Hydrocortisone 5mg tablets: £38.12

In contrast, many hydrocortisone 10mg tablets cost between £1.60 and £3.21 per pack.

This means lower-dose hydrocortisone tablets (2.5mg and 5mg) are more expensive than 10mg tablets. For this reason, people who have steroid-dependency often receive 10mg tablets and split them to get the correct dose. However prices can differ a lot depending on the manufacturer. For example, one brand of 2.5mg hydrocortisone costs £59.70, while another equivalent 2.5mg tablet costs £35.56.

People who are steroid-dependent should receive their hydrocortisone medication in a form that is safe, reliable, and appropriate for their individual needs. At the same time, we also need to understand that the NHS is under severe financial pressure and not everyone will clinically need lower-dose tablets so can happily split their 10mg tablets.

For those who have no issues splitting their 10mg tablets for their different doses, either by hand or using a pill cutter, this is great! If a certain brand is easier for you to split, you can ask your GP to note on your repeat prescription that this brand of 10mg tablets should be supplied by the pharmacy.

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When lower-dose tablets are needed

There are groups of people with steroid-dependency where prescribing 2.5mg and/or 5mg tablets is clinically justified and appropriate. These include:

• People who cannot reliably split tablets, such as due to poor dexterity, visual impairment, or cognitive difficulties.
• Children and young people who need accurate doses and may feel self-conscious about splitting tablets at school or with their peers, which can make it hard for them to keep to their medication regimen and up-dose.
• Patients who are very dose-sensitive, including those who experience symptoms with small dose changes.
• Patients experiencing crumbling or unreliable splitting, even with scored tablets.
• Patients advised by their endocrinologist to avoid tablet splitting or brand changes.

For these groups, requesting lower-dose tablets is not a preference or convenience issue, but a clinical need and those needs should be met. Clarifying this helps ensure those with steroid dependency feel confident advocating for themselves and that GPs understand the genuine need, justifying the extra cost to the NHS.

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Reporting problems with splitting tablets

Some members have been in touch to report issues with Accord 10mg hydrocortisone tablets crumbling when split. Understandably this makes people concerned they are not receiving the right dose.

Not all people with steroid-dependency receive this brand of 10mg hydrocortisone tablets, so this may not impact you. However if you are having issues with your Accord 10mg tablets, please:

• Report via the Yellow Card Scheme
• Report to Accord (the manufacturer) as crumbling may indicate a batch issue. You will be asked for the batch number on the tablet box, so have these details to hand. You can report via their website here, or email [email protected]

Individual reports are important as the more evidence submitted, the more seriously this issue is taken. 

Statement from Accord-UK Ltf & Next Steps

ADSHG has followed up on this issue with Accord-UK Ltd, who have provided a full statement, which you can read here. In summary, they have acknowledged a quality issue, notified the Medicines & Healthcare products Regulatory Agency (MHRA), and, following a full assessment, it was agreed that a product recall was not required due to the potential impact on market supply.

If you are affected, the current recommendation remains and you should discuss one of the following options with your GP:

1. Add a note on your repeat prescription specifying that Accord 10mg tablets should not be dispensed by your pharmacy and that an alternative manufacturer should be used instead.
2. Add lower-dose hydrocortisone tablets to your repeat prescriptions so you do not need to split 10mg tablets.

To support you in this conversation, we have a one-page document which you can view below, for you to take or send to your GP. This explains the situation, includes Accord's full statement and asks for these alternatives to be provided.

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Talking to your GP

If you are experiencing issues with your hydrocortisone prescription and would like your GP to add lower-dose tablets to your repeat prescriptions, here are some tips to help you show your clinical need and support your conversation:

• Highlight your clinical need for lower doses: especially if you have dexterity, visual impairment, or cognitive difficulties, have trouble taking your medicine throughout the day as prescribed, or have been advised by an endocrinologist.
• Explain your symptoms clearly: let your GP know if you are experiencing fatigue, dizziness, or other changes when splitting tablets.
• Mention any difficulties splitting tablets: including crumbling or uneven dosing.
• Request a certain hydrocortisone brand: if a certain brand is easier for you to split, discuss with your GP if they could add a note on your repeat prescription that this brand of 10mg tablets should be supplied by the pharmacy.
• Bring documentation: print out our support document to discuss with your GP, or any endocrinology advice, as this helps your GP make informed decisions.

If you are not affected by any of the issues above, your GP may decide not to approve the request of adding lower-doses to your repeat prescription because of the additional costs, particularly given the financial pressure currently faced by the NHS.

We appreciate this can be frustrating so to speak to others who 'get it', remember our online forum is always there for you. Pill cutters (sold in pharmacies) can be helpful and on our online shop we have both a pill pocket and a pillbox keyring to help you store those split doses.

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Summary

Lower-dose hydrocortisone tablets (2.5mg and 5mg), cost much more than higher-dose tablets (10mg). However for some who are steroid-dependent, lower-dose tablets play an important and necessary role in managing their condition. The ADSHG recognises the realities of NHS budgets, so is here to provide you with the information you need to have discussions with your GP if you feel you would benefit.

Due to the reported issues of crumbling 10mg hydrocortisone tablets and Accord's response, we have produced a one-page document to help discuss this with your GP and support our community in accessing safe, reliable treatment.

Remember if you are experiencing any medical problems, please speak to your pharmacist, GP, or endocrinology team.

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