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Government admits HRT PPC will create additional 'costs' for pharmacies

The government has admitted that the new pre-payment certificate (PPC) for hormone replacement therapy (HRT) will create additional “costs” for pharmacies.

The Department of Health and Social Care (DH) last month confirmed that the new PPC will come into effect from April 1, meaning women in England will be able to access cheaper HRT for menopause.

At the time, the Pharmaceutical Services Negotiating Committee (PSNC) warned that the move will “introduce additional workload and financial risk for community pharmacy teams”.

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

Now the government has admitted this risk in DH guidance published last week (March 22) by the NHS Business Services Authority (NHSBSA).

“The DH recognises that upon launch, the HRT PPC will require some workarounds for pharmacy contractors (including other dispensary staff) and that there will be associated costs until solutions are in place,” the guidance said.

For instance, pharmacy teams could incur “costs” as a result of “mixed prescriptions issued in error” – where both HRT and another treatment appear on the same script – while there is no “digital solution to automate the process”, it added.

The DH “will continue to work with the sector seeking to mitigate and minimise the impact on pharmacy teams”, it said.


“Totally unacceptable”


PSNC also last week (March 24) published new guidance on the HRT PPC, slamming NHS systems for not keeping “pace with policy”.

PSNC chief executive Janet Morrison said that the introduction of the PPC “is a positive development for patients” and that the negotiator has argued for the medicines to be made available for free.

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

But she added that it is “totally unacceptable” that the certificate is “launching without the IT in place to support it”.

"Community pharmacies cannot on the one hand be subjected to funding cuts, but on the other hand be expected to keep picking up the pieces when the DH and the NHS launch policies without having the infrastructure in place to effectively implement them,” she said.

C+D approached the DH for comment.


“Financial compensation”


Ms Morrison added that PSNC warned ministers directly that rolling out the HRT PPC “at this point” risks causing “confusion” for patients and will “add to the burden on pharmacies”.

However, the government “is determined to move forwards with the policy” despite recognising the “impact this will have on pharmacies”, she said.

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

The negotiator is “pressing for appropriate financial compensation for pharmacy owners”, as well as seeking guidance for GPs, she added.

PSNC said it was “in discussion” with the DH about compensation to mitigate any “associated costs for pharmacy owners until IT solutions are in place”.

It aims to “ensure pharmacies are properly compensated for the time, effort and risks associated with the introduction of the HRT PPC, and in particular mixed prescriptions”, it added.


Mixed prescriptions


Patients with an HRT PPC will continue to pay prescription charges for any other non-HRT medicines unless they are exempt for another reason, the PSNC guidance said.

GPs will be required to write HRT items on separate prescriptions because scripts cannot be processed as both exempt and paid on NHS systems, but on occasion may issue a “mixed prescription”, it added.

Read more: HRT patch out of stock from end of February due to ‘production bottleneck’

The PSNC guidance set out the “risks” for contractors dispensing or part-dispensing mixed prescriptions to a patient with an HRT PPC.

These include deductions of a prescription charge from their remuneration where no charge was collected – resulting in financial loss to the pharmacy – or claiming an item as exempt where a prescription charge was collected, it said.

Read more: DH to hike prescription charges by 30p from next month

The latter results in an overpayment to the pharmacy and the additional work of dealing with NHS recovery of the overpayment, as well as “the potential for serious allegations against the pharmacy”, it added.

The DH has advised pharmacies to refuse to dispense mixed prescriptions to patients with an HRT PPC, unless they need one or more of the items urgently.


IT solutions


Although the PPC will be available to patients from April 1, IT solutions will not be in place on that date for prescribers to automatically issue separate prescriptions, PSNC’s guidance said.

Instead, prescribers will be required to “manually issue prescriptions for all listed HRT medicines as single-item prescriptions” until auto-separation of eligible HRT medicines is available, it added.

Read more: Government reportedly ditches script fee change proposals for over 60s

It said that the DH has confirmed the technology will be in place “as soon as possible” but that it “has not provided any clear indication on the timescales required to achieve auto-separation”.
PSNC added that it is “concerned that mixed prescriptions may continue for some time” and it will continue “pressing” the DH to update prescribing systems.
Meanwhile, coding has been released to dispensing system suppliers for updating PMR systems with a new exemption category, the guidance said.
The DH has “recommended” that the updates be completed ahead of April 1 and it is “expected that the majority, if not all, suppliers” will have the new category available by then, it added.


DH: working on solutions


A DH spokesperson told C+D that it is "working to introduce a digital solution to automate the issuing of listed HRT items as single-item prescriptions at the point of prescribing as soon as possible".


“We’ve also published guidance on the options available for pharmacy contractors and will continue to work with the sector seeking to minimise the impact on pharmacy teams until the digital solution is in place," they added.


The spokesperson stressed that this "should not prevent people from accessing the HRT PPC".

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