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PSNC: HRT pre-payment certificate poses 'financial risk' to pharmacies

The pharmacy negotiator has raised concerns that a new pre-payment certificate (PPC) for HRT will cause “additional workload and financial risk” for pharmacy teams.

The Department of Health and Social Care (DH) yesterday (February 21) confirmed that women in England will be able to access cheaper hormone replacement therapy (HRT) for menopause through a new PPC from April.

But the Pharmaceutical Services Negotiating Committee (PSNC) raised fears that the new plans will “introduce additional workload and financial risk for community pharmacy teams”.

Read more: DH extends HRT SSPs and issues new protocol for paracetamol

It said that while it “remains fully supportive” of making HRT more accessible to women at a reduced cost, it believes that the introduction of this new PPC specifically for HRT medicines is “complex”.

“In some circumstances, it will not work well with existing prescription processing and pricing systems currently used in England,” PSNC added.


“Difficulties for patients”


And it said that the new system “may also cause difficulties for patients unless the HRT prescription item is written on a separate prescription to other paid prescription items”.

PSNC added that it wrote to ministers in November 2022 “highlighting [its] concerns” and “made repeated representations” that HRT medicines should instead be made free of charge like contraceptives.

This would be “easier to implement and more cost-effective”, it said.

Read more: Menopause APPG calls on government to ‘urgently scrap’ HRT prescription costs

However, although the government “recognised the issues”, it has “decided to press ahead with the policy”, it added.

PSNC is working with the DH to “understand what actions will be required by pharmacy contractors and to seek mitigations to the issues [it has] highlighted”, it said.

It added that it understands the DH will issue guidance to support pharmacy teams with the rollout of the PPC and that it will itself publish further guidance for contractors “once details of the changes are finalised”.


April rollout


From April 1, women in England will be able to purchase an annual HRT PPC for the cost of two single prescription charges, which currently amounts to £18.70.

Women will be able to apply for the PPC through the NHS Business Services Authority website or at a pharmacy registered to sell SSPs.

It will be valid for 12 months and can be used against any listed HRT prescription items an unlimited number of times – although women will still have to pay for any other prescribed medicines that fall outside of its scope.

Read more: Pharmacists tell health secretary of potential solutions to HRT supply issues

However, existing three and 12-month PPCs “may remain a more cost effective method of paying for prescriptions” for those who need multiple medicines, the DH said.

It added that the PPC will help around “400,000 women save hundreds of pounds a year, reducing their HRT costs to less than £20 a year”.

Around 15% of women aged 45-64 in England are currently prescribed HRT, up from around 11% in the last two years and increasing “rapidly”, according to the DH.

Abolish prescription charges


Royal Pharmaceutical Society (RPS) chair Thorrun Govind said that while the PPC is “great news for women in England who need HRT” as it “makes vital medicines more affordable”, prescription charges should be “abolished” altogether for those with long-term conditions.

“It remains inequitable that people with other long-term conditions still have to pay the prescription charge, which is in effect an unfair tax on health,” she said.

“No one should face a financial barrier to getting the medicines they need,” she added.

Read more: PSNC: Contractors need ‘assurances’ on impact of HRT prescription changes

The RPS wants to see prescription charges “abolished for everyone with long-term conditions so medicines are free to access in England, just as they are in the rest of the UK”, Ms Govind said.

The DH said that it is also “continuing work with suppliers to encourage and support them to boost supply to meet growing demand”, as well as issuing serious shortage protocols “when needed to even out distribution”.

It comes as it last week extended two SSPs for Estradot HRT patches after issuing a medicine supply notification for three kinds of estradiol Estradot patches earlier this month – as well as extending three SSPs for HRT drug Sandrena until next week.

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