HRT Prepayment Certificates

From 1st April 2023, women who usually pay for their HRT prescriptions will be able to purchase an annual HRT prepayment certificate (HRT PPC) for the cost of two single prescription charges (currently £19.30). The HRT PPC will be valid for 12 months from the date of application, and there will be no limit to how many times the certificate can be used whilst it is valid for prescriptions for HRT medications.

The list of eligible HRT medicines will be published in the England & Wales Drug Tariff part XVI from April 2023. To be included on the HRT medicines list, the medicine must be HRT containing oestrogen and / or progestogen and must be licensed for treatment of menopause in the UK. Off-licence testosterone products, which are increasingly being used by women to manage menopause symptoms are not included in the list of drugs covered by the HRT PPC. The HRT PPC will be valid for any product on the HRT medicines list, whatever the clinical reason for the prescription.

The HRT PPC will be available to purchase through the NHS Business Services Authority website or in person at a pharmacy registered to sell PPCs. For patients who need multiple medicines, the existing PPCs may remain a more cost effective method of paying for prescriptions.

The HRT PPC can be backdated up to one month from the date of application (but not prior to 1 April 2023).

Prescription forms:

Updated FP10s (version 0522), including EPS tokens, with the category ‘W’ for HRT PPC will be put into circulation from the beginning of April 2023 but old stock should be used until supplies are used up.

During the period of transition to the new prescription form a temporary workaround will be in place. If a patient holds a valid HRT PPC and the item prescribed is one of those included in the HRT medicines list, the patient should select box F (prescription prepayment certificate) on the current FP10/FP10DT. Procedures will be in place at NHSBSA to prevent patients using this workaround from receiving penalty charges unnecessarily.

Selecting box F (prescription prepayment certificate) must only be used when all the items on the prescription are for listed HRT only, NOT for a mixed charge prescription (one that has both items from the HRT medicines list and non-listed HRT items).

Mixed Prescriptions:

Mixed prescriptions are those that contain both items from the HRT medicines list and items not on the HRT medicines list. Until a digital solution is introduced to automate the issuing of listed HRT items as single-item prescriptions at the point of prescribing, prescribers will be required from 1st April to manually issue (e.g. via EPS) prescriptions for all listed HRT items as single-item prescriptions.

If pharmacies are presented with a prescription containing both HRT and other items and the patient has an HRT PPC they have three choices:

Refuse to dispense either items and ask the patient to return to the prescriber for separate prescriptions
If there is an urgent clinical need, dispense either the HRT or the other items, with the correct completion of the back of the prescription for either a PPC or paid items and ask the patient to return to the prescriber for a prescription for the non-dispensed item(s)
Dispense all items, charge the patient for the non-HRT items and issue and process an FP57 Receipt and Refund form for the HRT item (so that no money changes hands for this item) and process the prescription as a ‘Paid’ form

FP57 Receipt and Refund forms:

The FP57 (version 0423) has been updated to allow pharmacists to record the number of charges paid for items on the HRT medicines list separately from other prescription items. Old stock should continue to be used until it runs out, but new stock can be used once available if the refund is for items on the HRT medicines list.

The form allows the pharmacy processing the claim to confirm that a patient claiming a refund because they had a valid HRT PPC on the date the charges were paid are doing so against applicable medicines only i.e. those on the HRT medicines list.

If the new FP57 is not available, the pharmacy should issue a separate ‘old’ FP57 for listed HRT items and another FP57 for any non-HRT items, with the HRT items in Part A of the form annotated with ‘Listed HRT’ and initialled to confirm the charges paid were for listed HRT items.

Processing EPS claim notifications after dispensing:

Dispensing system suppliers are updating dispensing systems to include the new HRT PPC exemption category. The HRT PPC exemption has been assigned box W and Electronic Reimbursement Message (EREM) code 0020.

Currently, due to the complexities of checking for exemption against specific medicines, RTEC is not available for confirming whether a patient has a valid HRT PPC. Changes to RTEC will be made as soon as possible.

Full DHSC Guidance document can be downloaded here

Medicines covered by the HRT PPC