Shutterstock.com
A report by the NHS Business Services Authority (NHS BSA) has revealed that pre-payment certificates (PPCs) for HRT have saved patients an estimated £11m in prescription fees in their first year.
The ‘Experimental Analysis: PPC savings and potential beneficiaries‘ report, published on 26 March 2025, found that around 466,000 patients may have saved around £11.2m in 2023/2024 by claiming an HRT PPC exemption.
The HRT PPC was introduced in April 2023 to provide help with health costs for certain HRT medicines and covers an unlimited number of prescriptions for eligible medicines for 12 months, regardless of why they are prescribed.
Patients can buy an HRT PPC for a one-off payment that is equivalent to the cost of two prescription items, which in 2023/2024 was £19.30.
Following its introduction, the report said there was a “notable drop” in the number of people paying for three or more prescription charges for HRT products in 2023/2024.
The proportion of patients paying for three or more HRT medications dropped from 62.8% in 2022/2023 to 40.9% in 2023/2024.
The report suggested that strong uptake of the HRT PPC in its first year “helped many people who would otherwise have paid three or more prescription charges”.
The non HRT-specific PPC covers the cost of all NHS prescriptions for a set price and is available for three or 12 months. In 2023/2024, the three-month PPC cost £31.25, and the 12-month PPC cost £11.60.
More than 3 million PPCs were issued in 2023/2024, of which two-thirds were the 12-month version. There has been a consistent year-on-year increase in the number of 12-month PPCs issued since 2018/2019.
In 2023/2024, a total of 936,000 three-month PPCs were issued, also reflecting an overall increase over the past five years.
The NHS BSA estimated that a further 872,000 patients could potentially have saved around £35.4m — £41 each on average — by purchasing a 12-month PPC in 2023/2024.
Commenting on the data, Louise Ansari, chief executive of Healthwatch England, said: “We welcome estimates from the NHS BSA that more and more people are benefitting from prescription savings due to the availability of PPCs.
“Removing the barriers people face to care, including costs for essential medications, is key to ensuring people can get the help they need and have the confidence that services are there when they need them.
“However, this analysis also shows that not enough people are benefitting from potential savings to their prescriptions,” she added.
“More must be done to ensure people are aware of available financial support, including better signposting to support and more funding for pharmacies to sell physical copies of PPCs. Improving technology systems to deliver proactive communications would also help patients, including notifying them when they could benefit from a PPC, or when their current certificate is about to expire.”
Rachel Power, chief executive of The Patients Association, said: “PPCs can be a lifeline for patients managing long-term health conditions, especially as the rising cost of living means many patients are facing impossible choices.
“PPCs can offer vital savings for people on long-term medication, but awareness is key. We need to ensure that patients are empowered to make informed decisions and access the options that will benefit them most.”
In 2023/2024, the number of HRT items dispensed in England rose by 22% to 13 million items, according to NHS BSA data.
This increase followed a 47% increase in HRT items dispensed the previous year, from 7.4 million items in 2021/2022 to 10.9 million items in 2022/2023.
In January 2024, the government announced that more than 500,000 women in England had accessed HRT using PPCs.
The NHS BSA said it will look to publish the report on PPC data annually.
