HRT prescription costs in England: the prepayment certificate explained

Combined HRT often involves two or more products, such as an oestrogen patch or gel and a progestogen, each of which needs a prescription charge in England. Costs add up. The NHS introduced a prepayment certificate for HRT in April 2023 so that women pay a single fee for a year of HRT items, rather than a charge for each item. The scheme is administered by the NHS Business Services Authority.

• A defined list of HRT products used for menopause symptoms, including oestrogen and progestogen products in different forms.

• All covered items on prescription during the twelve months, with no extra charge per item.

• Items on the list are published, and clinicians can check whether a product qualifies.

• It does not cover other prescribed medicines, which need their own certificate or charges.

People paying for HRT who are not exempt, particularly those taking more than one product per month. If you need only a single HRT item, compare the cost of a certificate with monthly charges. Those who are exempt from charges, for example because of age, medical conditions, low income or maternity exemption, do not need to pay. Check eligibility on the NHS website.

Apply online through the NHS Business Services Authority or ask a pharmacist for guidance. You need to provide personal details. A certificate can start straight away or on a future date. Keep the certificate number and show proof if asked. If you stop HRT part-way through the year, refunds depend on the scheme rules, so check them first.

Prescriptions are free at the point of dispensing in Scotland, Wales and Northern Ireland, so a certificate is not required. If you live in one of these nations but are registered with an English GP, charging depends on where the prescription is issued, so ask your pharmacist.

The certificate applies to NHS prescriptions. Private prescriptions are charged at the pharmacy price. Some people have a private consultation and then ask a GP to prescribe on the NHS; this depends on the GP agreeing to take over prescribing. Ask the private clinician what the arrangement would be.

Ask for 28- or 84-day supplies where appropriate to reduce visits. Make sure your repeat prescription is set up with the right products. Keep an eye on stock, because shortages occasionally affect specific brands, and ask the pharmacist about alternatives.

Before buying, add up what you expect to pay in a year. A woman using a patch and a progestogen who collects monthly will usually save by holding a certificate, while someone using a single product every three months may not. Ask your pharmacist to help with the sum, and check whether you might already be exempt. If your regimen is likely to change during the year, remember that the certificate covers listed HRT products, so switching brands within the list is generally fine.