HRT prescription prepayment certificate: what you need to know

The change comes into effect in England on 1 April

Menopausal women in England will save hundreds of pounds on HRT prescriptions when a prepayment certificate is introduced on 1 April.

Women can access HRT for menopausal symptoms at a reduced cost by paying a one-off fee for up to a year’s worth of treatment.

The new HRT prescription prepayment certificate, known as the HRT PPC, has been introduced after calls to widen access to HRT.

GP, menopause specialist and balance founder Dr Louise Newson said: ‘This is a step in the right direction: other hormones are freely available on the NHS to anyone so HRT should ideally be no different.

‘Research has shown that women living in more deprived areas are less likely to be prescribed HRT. There are many health benefits from taking HRT, including reducing future risk of heart disease and osteoporosis, which many perimenopausal and menopausal women are missing out from.

‘There are too many barriers for women to access menopause treatment and cost of HRT is one so I hope this will really make a difference.

‘However, it is disappointing to see that testosterone will not be covered by the certificate. Testosterone is recommended by NICE for symptoms of low libido when HRT alone is not helping, and in my clinic patients often say it helps with other menopausal symptoms including brain fog, energy levels and low mood. In addition Intrarosa pessaries, which are hormonal vaginal pessaries, are not included.’

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What is the HRT prescription prepayment certificate?

The HRT PPC is a bespoke certificate that will provide women access to HRT at a reduced cost.

Instead of paying for monthly prescriptions, women can access their HRT by paying a one-off charge the equivalent of two single prescriptions (£19.30 from 1 April).

The move could save women hundreds of pounds a year, according to the Department of Health and Social Care (DHSC). There will be no limit to how many times the certificate can be used, or how many HRT items it can be used for, during the 12-months it is valid.

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Why has it come about?

There have been numerous calls in recent years to widen access to HRT from women, campaigners, health professionals and politicians.

In October 2021 the government pledged to cut the cost of repeat HRT prescriptions by introducing the prepayment certificate.

Following delays, the government said in January 2023 that it was ‘committed to reducing the cost of HRT’ and that work was underway to deliver the certificate.

But it was unclear when the certificates would be made available, prompting further pressure on the government for a clear commitment.

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When does it come into effect?

The HRT PPC will be available in England from 1 April.

Women can apply for the certificate in person at a pharmacy registered to sell the certificates, or through the NHS Business Services Authority. A digital or paper copy will be made available.

Once it has been approved it will be available to use immediately on or after 1 April.

What does it cover?

The certificate will be valid against a range of HRT prescription items, including patches, tablets and topical preparations. It can be used for an unlimited amount of these treatments, DHSC confirmed.

A full list of treatments covered by the certificate can be found here.

Are there any concerns about the rollout?

The Pharmaceutical Services Negotiating Committee (PSNC), the industry’s negotiating body, has warned the government is pressing ahead with the certificate without the IT in place to support it, risking confusion for both patients and pharmacies.

Speaking ahead of the launch, PSNC Chief Executive Janet Morrison branded the move ‘unacceptable’.

‘We have warned ministers directly that rolling out the HRT PPC at this point risks causing confusion for some patients and that it will add to the burden on pharmacies, but to no avail. The government recognises the challenges but is determined to move forwards with the policy.’

A DHSC spokesperson said it was working to introduce a digital solution to automate the issuing of listed HRT items as single-item prescriptions at the point of prescribing ‘as soon as possible’.

‘We’ve also published guidance on the options available for pharmacy contractors and will continue to work with the sector seeking to minimise the impact on pharmacy teams until the digital solution is in place,’ the spokesperson added.

‘This should not prevent people from accessing the HRT PPC.’

Dr Louise Newson added: ‘It’s extremely concerning to see a warning from the PSNC that this long-awaited scheme is going to launch without the IT in place to support it, risking confusion for both patients and pharmacies.

‘The right infrastructure must be in place if this much-needed scheme is to be the success we need it to be. I hear on a daily basis how many women struggle to access HRT; the last thing we need is yet another roadblock.

‘HRT isn’t a one-size-fits-all treatment, so another issue is that not all HRT products are covered by the new HRT PPC, meaning that some women will need two separate prescriptions. For example, a patient might need an Evorel patch, which is covered by the HRT PPC, and Intrarosa, that is not covered by the new certificate. This creates more work both for prescribers and those dispensing the medication.’

What about other parts of the UK?

The HRT prescription prepayment certificate will be made available in England only.

In Wales, Scotland and Northern Ireland all prescriptions, including HRT, are free.