Hormone replacement therapy pre-payment scheme is too ‘complex’, say pharmacy leaders

Women in England will be able to buy a new pre-payment certificate (PPC) for hormone replacement therapy (HRT) from 1 April 2023, the government has announced.

The certificate, priced at £18.70 (the cost of two single prescription charges) will cover 43 HRT products and be valid for 12 months, but pharmacy leaders have warned that the new system will increase workload and costs for community pharmacies.

In a statement issued on 21 February 2023, the Department of Health and Social Care said that women are able to apply for the new PPC through the NHS Business Services Authority or in person “at a pharmacy registered to sell PPCs” for use on or after 1 April 2023.

The DHSC says that the PPC can be used against a list of products that will be on its website, including patches, tablets and topical preparations.

Women with a certificate can present it to the pharmacist when collecting HRT products and complete the exemption declaration on the NHS prescription form.

The DHSC says that women who need multiple medicines, including some not covered by the HRT PPC, may find that existing 3 and 12-month PPCs are more cost effective.

There are increasing numbers of women taking HRT, with an estimated 1.9 million patients prescribed HRT in England in 2021/2022, compared with 1.5 million patients in 2020/2021 — an increase of nearly a third. This increase has been partly attributed to a change in the willingness of GPs to prescribe and increased public awareness of menopausal symptoms.

The Pharmaceutical Services Negotiating Committee (PSNC) said in a statement that although it was “fully supportive” of making HRT medicines more accessible, there were better ways to do it.

In the statement, issued on 21 February 2023, the PSNC said: “We believe that the introduction of this new PPC specifically for HRT medicines is complex, and in some circumstances it will not work well with existing prescription processing and pricing systems currently used in England.

“The implementation of this new type of PPC will introduce additional workload and financial risks for community pharmacy teams.”

The statement added that the organisation wrote to the DHSC in November 2022, outlining its concerns and suggesting instead that HRT products should become free-of-charge items, similar to hormonal contraceptives, as a more cost-effective and less complex alternative.

“However, while government recognised the issues, the minister has decided to press ahead with the policy and we are still working with DHSC to understand what actions will be required by pharmacy contractors and to seek mitigations to the issues we have highlighted,” the statement said.

A spokesperson from the British Menopause Society said: “The British Menopause Society welcomes this move to make HRT more widely accessible and also more affordable for many women.

“A single-cost annual charge could help women living on low incomes, who might otherwise prioritise other family members, rather than themselves.”

Thorrun Govind, chair of the Royal Pharmaceutical Society’s English Pharmacy Board, said: “The PPC is great news for women in England who need HRT to manage symptoms of the menopause, as it makes vital medicines more affordable.

“However, it remains inequitable that people with other long-term conditions still have to pay the prescription charge, which is, in effect, an unfair tax on health,” she added.