HRT prepayment certificate to cover all HRT items licensed to treat the menopause

Exclusive: Anyone will be able to apply for the HRT prepayment certificate, which will be available from April 2023.
Hormone replacement therapy (HRT) transdermal patch on skin

The Department of Health and Social Care has confirmed that the hormone replacement therapy (HRT) prepayment certificate will cover all HRT items that are licensed to treat the menopause.

In some circumstances, HRT medication may be provided for other indications, such as transgender hormone therapy.

On 25 January 2023, Maria Caulfield, health minister and minister for women, confirmed to the House of Commons that the HRT prepayment certificate would be available from April 2023, meaning that women in England will only need to pay £18.70 per year for all their HRT prescriptions.

On 24 January 2023, the UK government’s response to a report published by the House of Commons Women and Equalities Committee on menopause and the workplace said that it was “committed” to reducing the cost of HRT prescriptions but that the “bespoke” prepayment certification was “subject to consultation with all relevant representative bodies” which, it said, was “still ongoing”.

It has now been confirmed that the HRT prepayment certificate will cover all HRT items licensed to treat the menopause in England, a list of which will be published in the online Drug Tariff and as part of the application process for the certificate.

Anyone prescribed HRT will be able to apply for the certificate, which can be used against any HRT with a licensed indication for menopause.

However, Paula Briggs, consultant in sexual and reproductive health at Liverpool Women’s NHS Foundation Trust and chair of the British Menopause Society, told The Pharmaceutical Journal that people with symptoms of the menopause who are taking multiple medicines may be better off getting a normal NHS prescription prepayment certificate (PPC).

A standard PPC covers all a patient’s NHS prescriptions for a set price, which is currently £30.25 for 3 months or £108.10 for 12 months.

“The number of women of this sort of age who are not on any other medication will be quite low [and] if you happen to be on testosterone, that’s not covered, so you’re left paying for that anyway,” she said.

Briggs also said she felt it was “wrong” to pick out one therapy area and preferentially reduce the cost of that when other people have to pay for medication for conditions that “are just as difficult to cope with”.

“Other devolved nations don’t pay for prescriptions. We either should have gone ‘nobody pays’, which would have been the fairest thing, or promote that you can pay for your prepayment certificate monthly — that is a much more cost-effective option.”

Ben Merriman, a primary care network pharmacist at Morecambe Bay Primary Care Collaborative, said that while he “applauded” the government’s intentions to reduce the cost of HRT, he said he could think of “a number of issues” that will need to be clarified before the change can be implemented.

“A range of non-hormonal medicines — such as antidepressants, clonidine and gabapentin, as well as low-dose testosterone and tibolone — are used either alongside or instead of HRT and, given these medicines have other uses, there will need to be clarity as to whether these medicines will be covered by a prescription prepayment certificate.

“If they are, how that will be administered when they’re used for other indications? Will women needing only oestrogen pay only one prescription charge?”

“A much fair and simpler solution would be to abolish the prescription charge altogether,” he added.

“It is an unfair and outdated tax on the sick, and has already been removed in Scotland, Wales and Northern Ireland. I would be keen to see how much income is generated from the prescription charge, versus the cost of running and policing the exemption scheme.”

Last updated
The Pharmaceutical Journal, PJ, January 2023, Vol 310, No 7969;310(7969)::DOI:10.1211/PJ.2023.1.173709

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