PCA(P)(2023)18 - NHS England HRT Pre-payment Certificates (HRT PPCs)

Published: 28/04/23

Purpose

This Circular advises NHS Boards and community pharmacy contractors of the new hormone replacement therapy Pre-Payment Certificates that have been introduced in NHS England in April 2023.

People visiting from England may attend a community pharmacy with a prescription for dispensing and may hold an HRT PPC. This circular outlines action that pharmacy teams should take to ensure correct processing of forms and reimbursement.

Background

On 1 April 2023, the Department of Health and Social Care (DHSC) introduced a new Prescription Prepayment Certificate (PPC) to reduce the cost of hormone replacement therapy (HRT) for people in England.

The PPC covers specific listed HRT products, not all HRT. The certificate will be valid for 12 months and covers an unlimited number of listed HRT medicines for the cost of two single prescription charges.

These arrangements only relate to the dispensing of NHS England FP10 prescription forms.

HRT products

When a person presents with an NHS England HRT PPC, pharmacy contractors should check that the person’s prescribed products are covered by the HRT PPC. For a list of eligible HRT medication, visit: www.nhsbsa.nhs.uk/hrt-ppc-medicines

The current list of products is attached as Annex A. It should be noted that the list of eligible HRT medication is subject to change. Any HRT product not listed will attract the usual NHS England prescription charge unless the person has another form of exemption.

FP10 forms and the exemption box

Current stocks of the FP10 prescription forms are still being used up but a new FP10 form will shortly be available. The new FP10 will include an exemption box ‘W’, to enable people with a valid HRT PPC to claim the exemption to which they are entitled. Annex B contains an example of the new FP10 form with exemption box ‘W’.

If the prescription form received is the old version without a box for HRT PPC, a person should tick box ‘F’ instead. Selecting box F (prescription prepayment certificate) must only be used when all the items on the prescription are for listed HRT only.

From 1 April, prescribers have been asked to ensure all listed HRT items should be prescribed as single-item prescriptions (i.e. separate from all other prescription items, including other listed HRT items) to allow people to claim the exemption correctly. The NHS BSA guidance states that where a person holds a valid HRT PPC and presents a mixed prescription it should be returned to the prescriber so that separate prescriptions can be issued. HRT and chargeable items cannot be dispensed from a single prescription where the person is claiming exemption from charges because they hold a valid HRT PPC.

However, where the person is visiting Scotland it may not be practicable for them to receive a new prescription from their prescriber. The BSA guidance says pharmacists may, at their discretion, dispense urgent items on the mixed prescription. Where it is not possible to obtain a new prescription from the prescriber and the person needs the items during their visit, the following process should be followed:

• If the non-HRT items are urgent, the appropriate charge should be levied.

• If the HRT items are urgent, these can be dispensed free of charge against a valid HRT PPC.

• Items not supplied should be marked 'not dispensed' or 'ND'.

• The person should request new prescriptions for any items not dispensed.

• If all items are required urgently the only option is for a person to pay for all items and claim a refund when they return to England.