The HRT prepayment certificate, explained

What it is

Ordinarily each NHS prescription item carries a charge. Someone on combined HRT often needs two separate items, oestrogen and progesterone, which means paying twice each time a prescription is issued.

The HRT PPC replaces that with a single annual payment. It costs the equivalent of two standard prescription charges and lasts twelve months.

If you need more than two HRT prescription items a year, and almost everyone on ongoing HRT does, it saves money. For most women on continuous treatment the saving is substantial.

What it covers

Specified HRT items only: oestrogen and progesterone preparations used for menopausal symptoms, including patches, gels, sprays, tablets and some vaginal preparations.

It does not cover other medicines. If you take other prescriptions too, a general prescription prepayment certificate may suit you better, and you cannot use both to double up on the same item.

Where it applies

England only. Prescriptions are already free in Scotland, Wales and Northern Ireland, so there is nothing to prepay.

How to get one

Through the NHS Business Services Authority, online or by phone. It can be backdated a short period, so if you have recently paid for HRT prescriptions it is worth checking whether that applies to you.

You buy it yourself; it is not something your GP arranges.

Where it does not help

The certificate covers the cost of the medicine on an NHS prescription. It does not address the other cost, which is access.

If you cannot get a GP appointment for weeks, if you have been told to come back when it is worse, or if you are on a treatment that is not right and cannot get it adjusted, a prepayment certificate does not solve any of that. It makes the medicine cheaper once you have it.

That is the honest gap, and it is the gap private services exist in.

Comparing the two routes

NHS route. The prepayment certificate covers your medicine for a year. Appointments, reviews and dose changes go through your GP practice, subject to their availability.

Private route at fira. £75 a month, or £180 a quarter. That covers the assessment, the clinician review, the prescription, delivery, and every dose adjustment. There is no consultation fee, and the price does not change with your dose.

The NHS route is cheaper for the medicine. The private route buys speed and access to adjustment. Which is right depends on whether your problem is the cost of the drug or the difficulty of getting seen.

If your GP is helping and you can get appointments, the prepayment certificate is very likely your best option, and we would rather say so than pretend otherwise.

Worth knowing

• Some people are exempt from NHS prescription charges entirely, in which case the certificate is unnecessary.
• Vaginal oestrogen prescribed alongside systemic HRT may be a separate item, which affects the maths.
• Charges are reviewed periodically, so check current rates on the NHS website before deciding.