Prepayment scheme for HRT to start in April 2023

A single annual prepayment of £18.70 for hormone replacement therapy (HRT) prescriptions will be introduced in April 2023, the pharmacy minister has said.

The scheme was first announced in October 2021 and promises potential savings of up to £205 by enabling women to pay one charge for a 12-month supply of HRT.

The time frame for implementation has been met with disappointment, with some having been led to believe the scheme “would happen in a matter of months”.

However, while giving evidence to the Women and Equalities Committee on 16 March 2022 as part of their inquiry into ‘Menopause and the workplace’, pharmacy minister Maria Caulfield MP said the government was looking into the scheme but anticipated that it would not be in place until “April next year”.

“This is different to prepayment certificates that are in existence for other medications now,” she explained.

“And we have to do a consultation with the various bodies — the pharmacy bodies and Royal Colleges — around the practicalities of rolling this out.”

Under the scheme, Caulfield explained, women would pay £18.70 per year for the certificate, which would give them access to as many HRT products as needed over 12 months.

The certificate would then “be logged with the pharmacist and instead of having to go back to the GP to get that prescription issued every month, the pharmacist would be able to automatically dispense it”, she added.

When asked by Bell Ribeiro-Addy, Labour MP for Streatham, why the scheme was taking so long to start, Caulfield said that some of the “technical details” were “out of our hands”.

“In the meantime, because NICE [National Institute for Health and Care Excellence] guidelines allow GPs, after an initial three-month period of being on HRT, to issue 12 months’ worth of HRT which would just involve one payment — that can happen now,” she continued.

In response to Caulfield’s comments, Carolyn Harris, a Labour MP for Swansea East, wrote in a letter — which she also published on Twitter — that she was “disappointed” to have heard about the April 2023 start “in this way”.

“Whilst I always understood that the changes required would take some time, I was led to believe by the Department [of Health and Social Care] that implementation would happen in a matter of months.

“This is the message that I have shared with the many women who have written to me since October [2021] asking for clarification, frustrated by the delay and the continued need for them to pay for their prescriptions to be fulfilled every month.”

She added that many women had asked their GP to prescribe a 12-month supply of HRT “but have struggled” because medical professionals were “not sufficiently aware” of the NICE guidelines.

“There is also the issue of supply, with stocks of HRT products already low at the present time, an issue that will only be made worse if women are trying to obtain 12 months’ worth of medication at one time.”

In June 2021, Harris presented the Menopause (Support and Services) Bill to parliament, with the aim of making HRT free for all women. The Bill was withdrawn following the government’s announcement of the new HRT payment scheme in October 2021.

Nuttan Tanna, pharmacist consultant in women’s health and osteoporosis at London North West University Healthcare NHS Trust, who runs outpatient secondary care menopause and osteoporosis medicines management clinics, said there was always “a dilemma” with prescribing annually.

“Once settled on their HRT, many women ask if we could recommend that the GP prescribes HRT for a longer period than the two or three monthly duration that the GP usually prescribes for,” she said.

“It would be good for the women as they would only pay one prescription charge; however, if the prescription needs to be changed within that year, then there will be the issue of wastage — an issue that the NHS is already struggling with, with other medicines prescribed for a longer period.”

Tanna said a system where women pay one charge per year but only get a three-month supply at a time to allow flexibility for the HRT regimen to change if needed, would be preferable.

“How this then dovetails with prepayment certificates also needs to be considered,” she said. “I guess I would rather that the system that is implemented is properly thought through and then put in place.”

Responding to Caulfield’s comments, Thorrun Govind, chair of the Royal Pharmaceutical Society English Pharmacy Board, said: “Delaying this move will only drive further health inequalities already experienced by women across England.

“We believe everyone should have access to medicines and will continue to call on the government to scrap prescription charges in England altogether.”