This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo

Menopausal Women to be Offered Cheaper HRT

A new prescription prepayment certificate (PPC) is to offer appreciably cheaper hormone replacement therapy (HRT) for menopausal women in England. The change could save an estimated 400,000 women a year up to £205 a year each.

Under the new scheme, announced by the Department of Health and Social Care (DHSC) today, from 1 April women will be able to access as many HRT products as they need during a full year for £18.70 – currently the cost of two single prescription charges.

Victory for 'Menopause Warriors'

Campaigners, dubbed 'menopause warriors' and spearheaded by Labour MP for Swansea East Carolyn Harris, had been pushing for free HRT in England, to match the arrangements in Scotland and Wales. However, a private members' bill tabled by Ms Harris in June 2021 aimed at scrapping HRT prescription charges was withdrawn in October that year, following the Government's announcement of the new HRT pre-payment scheme.

To the activists' disappointment, the introduction of the new PPC was delayed while the Government consulted with pharmacy bodies and Royal Colleges about the practicalities of its roll out. There was particular concern that annual prescribing could exacerbate recent shortages of HRT medications, and that if prescription needs changed during the year it could lead to medication wastage.

The Government also said it accepted the recommendations of the HRT Taskforce, which included encouraging and supporting manufacturers to boost medication supply to meet growing demand. The Department said it would also continue to issue serious shortage protocols – allowing alternative products to be dispensed when necessary – when needed to even out distribution, reducing the need for a woman to return to her GP for another prescription.

GPs Unaware of NICE Guidelines

Currently, National Institute for Health and Care Excellence (NICE) guidelines state that after a woman has been using HRT for an initial period of 3 months, her GP can issue 12 months' worth of HRT, which would involve just one payment. 

Ms Harris, expressing frustration with the PPC delay, highlighted in an open letter to Minister for Women Maria Caulfield last March that women often struggled to get their GPs to do this because GPs were often unaware of the NICE guidance. As a result, many women had been forced to continue to pay prescription charges every month.

"The delays, the post-code lottery of GPs' willingness to prescribe HRT, and the HRT supply shortages are unacceptable," Ms Harris said on Twitter.

Under the new arrangements, women will need to apply for an annual PPC through the NHS Business Services Authority, or in person at participating pharmacies. The certificate will then be logged with the pharmacist, who will be able to dispense items automatically, instead of a woman having to go back to her GP for a monthly or quarterly prescription. 

An annual certificate can be used across the range of HRT prescription items, including patches, tablets, and topical preparations, and there will be no limit on how many times the PPC can be used while valid.

'A Huge Moment' for Improving Women's Health 

Ms Caufield, a former nurse, said: "Around three-quarters of women will experience menopause symptoms, with a quarter experiencing severe symptoms - which can seriously impact their quality of life.

"Reducing the cost of HRT is a huge moment for improving women's health in this country, and I am proud to be announcing this momentous step forward."

About 15% of women aged 45-64 in England are currently prescribed HRT, up from around 11% just 2 years ago, and the rates continue to increase, according to DHSC figures. Around 10% of women on HRT use two different products. 

The NHS says menopause symptoms typically last around 4 years, but around 1 in 10 women experience them for up to 12 years.

Welcoming the DHSC's proclamation, Dr Ranee Thakar, president of the Royal College of Obstetricians and Gynaecologists, said: "We know that cost can be one of the barriers that women face in accessing treatment to manage their symptoms during menopause, and the introduction of HRT PPCs is a positive step to improve access to HRT. This announcement is an important first step, and we hope that more will be done to address the challenges and inequalities faced in accessing menopause care and treatment."