HORMONE Replacement Therapy (HRT) is an important treatment for many women going through the menopause, especially if they’re struggling with menopausal symptoms. However, the cost of prescriptions can add up, making affordability a concern. To address this, the HRT Prescription Prepayment Certificate (HRT PPC) was introduced. The aim is to help women to save money on eligible HRT medicines. But how does it work, what does it cover, and are there still shortages?
This article was included in issue 106 (Autumn 2025) of The Menopause Exchange newsletter.
What is the HRT Prescription Prepayment Certificate?
The HRT PPC is a cost-saving scheme introduced by the NHS to help women manage the expense of HRT prescriptions. Instead of paying separately for each prescription, women can purchase a 12- month HRT PPC for a fee of £19.80. This certificate covers an unlimited number of eligible HRT medicines within that 12- month period, making it more affordable for those requiring multiple prescriptions.
What does the HRT PPC cover?
The HRT PPC covers only certain HRT medicines prescribed by the NHS. If you need additional medicines that aren’t included in the scheme, you may need to pay separately or consider a standard Prescription Prepayment Certificate (PPC), which covers all NHS prescriptions. Before purchasing an HRT PPC, it’s advisable to check whether your required medicine is included. The list is available and regularly updated on the NHS Business Services Authority website (nhsbsa.nhs.uk.). If an HRT medicine is covered but you take it for reasons other than the menopause, you can still use an HRT PPC.
How do I access the HRT PPC?
You can buy the HRT PPC online through the NHS Business Services Authority website or at selected pharmacies. The certificate is valid for 12 months from the chosen start date, and you can print or download it for easy access. If you have already paid for an eligible HRT prescription, you may be able to claim a refund within three months, as long as you completed an NHS refund form (FP57) at the time of payment.
Do I pay separately for each HRT prescription?
Without an HRT PPC, you need to pay £9.90 per item on an NHS prescription. However, with the HRT PPC, you can obtain unlimited eligible HRT medicines for a single payment of £19.80 per year. This means that if you need three or more HRT prescriptions annually, the HRT PPC offers significant savings compared to paying per item.
Are there still HRT shortages?
Despite efforts to improve availability, HRT shortages continue to affect women in the UK. Increased demand, manufacturing delays and supply chain challenges are some of the reasons. Some women struggle to access their preferred HRT products, leading to frustration and uncertainty and poor menopause symptom control if HRT doses are missed.
What can I do about shortages?
If a particular HRT medicine is unavailable, you can check with multiple pharmacies to see if they have stock or speak to your GP about using an alternative HRT option. A community pharmacist can help you with information and updates on shortages and availability. You could also consider getting private prescriptions, but these may be more expensive and the shortage may also apply to the privately prescribed HRT option.
Is it safe to order HRT online?
Ordering HRT online can be safe if it’s through reputable sources. Ensure the website uses registered UK pharmacies that require a prescription – and avoid unregulated websites offering HRT without medical oversight. You can also check with your GP or a local pharmacist that the HRT available online has MHRA approval, which ensures medicines meet UK safety standards. While online pharmacies can provide convenience, unregulated sources may sell counterfeit or unsafe medicines. Always check the legitimacy of the pharmacy before buying HRT online.
Which HRT products can be bought over the pharmacy counter?
Gina 10 mcg oestradiol vaginal tablets and Ovesse oestriol 1 mg/g vaginal cream are available without a prescription for women aged 50 and over who haven’t had a period for more than a year. These are locally acting oestrogen-only HRT products designed to treat menopause related vaginal dryness and associated symptoms, such as painful sex and recurrent urine infections.
Ovesse may be more suited to external symptoms such as vulval itching or soreness. Gina 10 helps with symptoms of internal vaginal dryness and may feel less messy. The hormone is slowly released into your vaginal tissues to restore levels locally and help to relieve discomfort. The treatments are used daily for two weeks, then the dose is twice weekly, with three to four days between doses. Side effects are generally mild. Before buying an HRT product over the counter, you’ll need to have a consultation with a pharmacist to ensure it’s suitable for you.
Conclusion
The HRT Prescription Prepayment Certificate is a valuable scheme that helps women save money on eligible HRT prescriptions. While HRT shortages persist, there are ways to address availability issues. Ordering online can be safe if it’s through trusted UK pharmacies but, be careful to avoid counterfeit products. You may be suitable for vaginal HRT products available from community pharmacies without a prescription for menopausal vaginal dryness.
About the author
Dr Nuttan Tanna is a pharmacist consultant in women’s health. She is involved in research, education and policy work, and runs weekly menopause and osteoporosis medication management clinics at Northwick Park Hospital, in Harrow, Middlesex.
Created Autumn 2025
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