The government has a new policy from 1 April 2023 to support patients having menopausal symptoms with the cost of treatment. Patients who are not already exempt from NHS prescription charges will be able to purchase an annual HRT Pre-Payment Certificate for the cost of two single prescription charges - £19.80. This will only be valid for HRT preparations published in the Drug tariff Part XVI. These drugs can be prescribed for any clinical reason and still qualify for the HRT PPC.

The amended regulations require the script for HRT be issued separately from non-HRT items (whether paper or EPS).

We support the Government’s decision to make HRT medicines more accessible to patients at reduced cost, but we consider the introduction of this new prepayment certificate, specifically for HRT medicines, too complex.

GPC are disappointed that despite their advice, the DHSC has decided to proceed before the IT for automatic separation of prescriptions is ready, in contravention of the bureaucracy concordat, which they agreed to only a year ago. From 1 April, new FP10s will be introduced with a box ‘w’ for HRT PPC, but old stock can continue to be used with the patient selecting box ‘f’ general PPC and the dispenser checking for valid HRT PPC.

When applying for the HRT PPC patients will be advised that they must inform the practice/prescriber that they hold an HRT PPC and ask that the script be issued separately.

Pharmacy Contractors and dispensaries may either:

1. First, refuse to dispense a ‘mixed’ prescription presented by a patient – refuse to dispense both the listed HRT medicine and the other non-HRT item – and ask the patient to return to the GP for two separate prescriptions, or
2. Second, either: dispense the listed HRT medicine, or dispense the other non-HRT item(s) with the prescription charge(s) paid, or (This may be appropriate if the patient has an urgent clinical need for the listed HRT medicine or non-HRT item(s); the patient will need to obtain another prescription for any items not dispensed)
3. Third, dispense both the listed HRT medicine and the non-HRT item(s) – and complete an FP57 refund form for the listed HRT medicine (there is a charge and refund for the HRT medicines, so no money changes hands) and take a prescription charge for the non-HRT item(s).

Practices should discuss with their local pharmacies about local approaches to this guidance. GPC will continue to work with DHSC and system suppliers to ensure a digital separation solution is in place as soon as possible.

The patient can choose to apply for an HRT PPC backdated for up to 1 month. If they have not yet applied the pharmacy can issue a FP57 refund form. Patients who already have a valid 3 or 12- month pre-payment certificate for all their prescriptions will not need an HRT PPC. For patients that are stable on HRT we would recommend issuing via repeat dispensing at review, with one authorisation to cover a 12-month period, thus ensuring HRT is issued on a separate prescription.

Link for patients to purchase is here.