Court upholds CMA findings that firms charged excessive and unfair prices for lifesaving NHS-funded medicine

Court upholds CMA findings that firms charged excessive and unfair prices for lifesaving NHS-funded medicine
The Court of Appeal has confirmed that firms broke the law by charging excessive and unfair prices for hydrocortisone tablets over a decade.
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Prices for hydrocortisone tablets rose from less than £1 to over £70 per pack, meaning NHS annual spending rose from around £500,000 to over £80 million.
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The CMA found that Auden Mckenzie and Actavis UK charged excessive and unfair prices for hydrocortisone tablets between 2008 and 2018.
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Following appeals, the Competition Appeal Tribunal and the Court of Appeal have upheld the CMA’s findings.
The Court of Appeal (CoA) has today ruled that the Competition and Markets Authority (CMA) and the Competition Appeal Tribunal (CAT) were right to conclude that Auden Mckenzie and Actavis UK charged excessive and unfair prices for hydrocortisone tablets over a decade.
Tens of thousands of people in the UK depend on hydrocortisone tablets to treat life-threatening conditions such as Addison’s disease. In 2007, the drug cost less than £1 per pack. In 2008, Auden Mckenzie bought the licences for hydrocortisone tablets and began increasing prices.
Over the next eight years, Auden Mckenzie and Actavis UK (which took over Auden’s business in 2015) increased prices to over £70 per pack. NHS annual spending on the drug rose from around £500,000 in 2007 to over £80 million in 2016. The price increases did not reflect any increase in costs or investment in the drug, which was introduced in 1955.
When other firms began to develop their own hydrocortisone tablets Auden/Actavis bought them off. This allowed it to delay competition that could have brought prices down. Although other firms did eventually enter the market, Actavis UK retained market power and was able to continue charging excessive and unfair prices.
In July 2021, the CMA found that Auden Mckenzie and Actavis UK had abused a dominant position by charging excessive and unfair prices for hydrocortisone tablets between 2008 and 2018. The CMA also found that Auden/Actavis had entered into anti-competitive agreements with its competitors Waymade and AMCo. The CMA imposed penalties totalling £266 million.
In 2023, the CAT rejected the appeals of Auden Mckenzie and Actavis UK against the excessive and unfair pricing infringements. The CAT also upheld the CMA’s penalties for the abuses, subject to a £26 million reduction to the penalty for a former parent company to reflect a period when it did not control the business.
The firms appealed to the CoA. The CoA has today dismissed the firms’ appeals against the CAT’s judgment, finding that none of their grounds of appeal ‘get near’ to displacing the CMA’s and the CAT’s conclusions on the infringements.
Juliette Enser, Executive Director for Competition Enforcement, said:
After many years of fighting this case in the courts, this ruling shows once again we were right to take action against firms exploiting the NHS by charging excessive and unfair prices for a lifesaving medicine relied on by thousands of patients.
This ruling should send a clear message that we will not tolerate businesses ripping off the NHS. We will continue this fight and come down on any business breaking the law.
The CoA decided that the firms’ appeals on penalties should be remitted to the CAT for reconsideration – not because it accepted the firms’ arguments, but because it found that the CAT had not properly addressed them. The firms’ appeals against the penalties will be re-heard by the CAT.
Today’s judgment follows the CoA ruling in favour of the CMA’s appeal of the CAT’s decision to overturn its finding of a market sharing agreement on procedural grounds. This means all of the CMA’s findings of infringement against the firms have now been upheld on appeal.
Further details of the case as it progressed through the courts can be found on the CMA’s case page: Hydrocortisone tablets: alleged excessive and unfair pricing, anti-competitive agreements and abusive conduct (50277) - GOV.UK
Notes to editors
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Hydrocortisone tablets were sold initially by Auden Mckenzie (Pharma Division) Limited. Auden Mckenzie acquired the licences from their former owner, which had been selling the drugs for less than £1 per pack. Auden ‘de-branded’ the drugs, removing them from price regulation, and re-launched them as generic drugs at around £4 per pack, before increasing the prices to a peak of £72.
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The hydrocortisone business was transferred intra-group in 2015 to Accord-UK Limited (formerly Actavis UK Limited). The CMA held the parent companies Allergan plc (formerly Actavis plc), Accord Healthcare Limited and Intas Pharmaceuticals Limited liable for the excessive and unfair pricing during their ownership periods.
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The CAT ruled that Allergan could not be held liable as parent during the period 10 March to 1 August 2016 when its ownership of Actavis UK Limited was subject to ‘hold separate’ commitments given to the European Commission to secure merger control clearance for the sale of its generics business.
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Hydrocortisone tablets are sold in two strengths: 10mg and 20mg. The CMA found two abuses of dominance, one in relation to each strength.
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The CMA also found two anti-competitive agreements: one in relation to 20mg tablets, and another in relation to 10mg tablets. The CMA’s findings on the existence of the 20mg agreement were not appealed. The appeals against Actavis UK’s £2.8m penalty for the 20mg agreement were subject to a separate CAT judgment in 2024, which upheld the CMA’s penalty.
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The counterparty to the 10mg agreement was the AMCo undertaking, comprising the Amdipharm group and (for their ownership periods) its former parent Cinven and its current parent Advanz Pharma Corp Limited. The appeals against the 10mg agreement were subject to two CAT judgments. In the first, the CAT found that the Decision was right on the facts and that all the grounds of appeal failed. In the second, the CAT found that the appeals must nonetheless be allowed because the CMA did not fully put its case to a witness during cross-examination at trial. In September 2024, the CoA overturned the finding that the CMA had failed to put its case and held that the CAT’s procedure had been ‘unjust’.
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The penalties imposed by the CMA totalled £266.5m. £155.2m is attributable to the excessive and unfair pricing abuses and £111.3m to the anti-competitive agreements. Following the reduction in Allergan’s penalty to reflect the CAT’s findings on the hold-separate period, the total penalties stand at c. £240m.
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The CAT has not yet issued a judgment on the penalties for the 10mg agreement. A trial is listed in January 2027.
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Previous action taken by the CMA in relation to the pharma sector and the fines imposed:
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Prochlorperazine (2022): £35 million in fines for an illegal arrangement that restricted competition in the supply of prescription tablets (overturned on appeal).
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Phenytoin (2022): £70 million in fines for excessive and unfair pricing. The CAT’s 2024 judgment setting aside the Decision was overturned by the CoA in June 2026.
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Liothyronine (2021, upheld by the CAT in August 2023 and by the CoA in May 2025): £101 million in fines for excessive and unfair pricing (reduced to £99 million on appeal).
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Nortriptyline (2020): £3.4 million in fines and £1 million redress to the NHS for illegal arrangements including market sharing and information exchange.
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Fludrocortisone (2019): £2.3 million in fines and £8 million redress to the NHS for market sharing.
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Paroxetine (2016): £45 million in fines for anti-competitive agreements and abuse of dominance (reduced to £27.1 million on appeal).
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