The NHS HRT Prescription Prepayment Certificate (HRT PPC) lets you get an unlimited number of certain HRT medicines on NHS prescription in England for 12 months, for a one-off payment of £19.80, the same as two single prescription charges (NHSBSA). It launched on 1 April 2023 (GOV.UK), and you can buy one online, at a participating pharmacy or by phone.
This guide explains what it covers, whether it's worth it for you, and who doesn't need one at all.
Key takeaways
- It costs £19.80 and lasts 12 months. A single NHS prescription item in England usually costs £9.90 (NHSBSA).
- It only covers HRT medicines on the NHSBSA list, which are HRT medicines licensed to treat the menopause in the UK. Check yours is included (NHSBSA list).
- It doesn't cover other medicines, so HRT items need to be on a separate prescription (NHSBSA guidance).
- It's only needed in England. Prescriptions are free in Wales, Scotland and Northern Ireland (House of Commons Library).
Is HRT free on the NHS?
It depends where you live, and whether you qualify for free prescriptions.
In Wales, Scotland and Northern Ireland, yes — NHS prescriptions are free for everyone, HRT included (House of Commons Library).
In England, not usually. HRT is prescribed on the NHS, but you pay the standard charge of £9.90 per item unless you're exempt (NHSBSA). Because HRT is often two items, that can mean paying twice each time.
It is free in England if you're exempt — including if you're 60 or over, hold a valid medical or maternity exemption certificate, or get certain benefits (NHSBSA). The full list is below.
If you're not exempt, the HRT prepayment certificate caps it at £19.80 for 12 months, however many HRT prescriptions you need (NHSBSA).
What does the HRT prepayment certificate cover?
The HRT PPC covers a range of HRT medicines named on the NHS Business Services Authority (NHSBSA) list, including tablets, patches, gels, sprays, vaginal pessaries and creams, and combined products (NHSBSA list). A few rules are worth knowing:
- Only listed medicines count. It covers HRT medicines that are licensed to treat the menopause in the UK. It doesn't cover every HRT medicine, so check the list for yours.
- Generic versions count if the generic name is shown on the prescription.
- The reason doesn't matter. If your medicine is on the list, the certificate still applies even if you take it for a reason other than menopause.
- The hormonal coil is already free. A hormonal intrauterine system is a free contraceptive, so there's no prescription charge for it even when it's prescribed as part of menopause treatment.
- Other medicines aren't covered. Items covered by the HRT PPC can't be prescribed on the same form as other items, so ask for your HRT to be on its own prescription (NHSBSA guidance).
How much does it cost, and is it worth it?
The HRT PPC saves money if you get more than two qualifying HRT items in a year (House of Commons Library). If you also get other regular prescriptions, a standard PPC, which covers all NHS prescriptions, may work out better.
| Option | Cost in England | What it covers |
|---|---|---|
| Paying per item | £9.90 per item | That item only |
| HRT PPC | £19.80 for 12 months | Unlimited items on the HRT PPC list |
| Standard PPC, 3 months | £32.05 | All NHS prescriptions |
| Standard PPC, 12 months | £114.50 (can be paid in 10 monthly Direct Debit instalments) | All NHS prescriptions |
Sources: NHSBSA HRT PPC; NHSBSA PPC. Prices can change, so check the NHSBSA website for the latest figures.
How to apply for an HRT PPC
You can buy one (NHSBSA):
- online, through the NHSBSA website
- in person at a participating pharmacy
- by phone on 0300 330 2089 (Monday to Friday 8am to 6pm, Saturday 9am to 3pm)
A few practical points:
- You choose the start date. It can be up to one calendar month before or after the date you buy.
- Claiming back charges. If you pay for HRT before your certificate starts, ask the pharmacy for a refund receipt (FP57) when you pay. You need to claim within three months.
- No refunds on the certificate itself. HRT PPCs are non-refundable, so check whether you already qualify for free prescriptions first.
HRT exemption list: who doesn't need to pay
In England, you already get free prescriptions if you (NHSBSA):
- are 60 or over, or under 16, or 16 to 18 and in full-time education
- are pregnant or have had a baby in the last 12 months and have a valid maternity exemption certificate
- have a valid medical exemption certificate
- get certain benefits, such as Pension Credit Guarantee Credit, or Universal Credit with earnings below the threshold
- have an HC2 certificate through the NHS Low Income Scheme
- have a valid war pension exemption certificate
In Wales, Scotland and Northern Ireland, prescriptions are free for everyone, so there's nothing to buy. Charges were abolished in Wales on 1 April 2007, in Northern Ireland in April 2010, and in Scotland on 1 April 2011 (House of Commons Library).
When to see a GP
A prepayment certificate only covers the cost. Whether HRT is right for you, and which type, is a clinical decision. The NHS says the benefits of HRT usually outweigh the risks for most women, but there are risks, including a small increase in breast cancer risk with combined HRT and a raised risk of blood clots with tablets (not with patches, gels or sprays) (NHS).
See a GP or menopause clinician if:
- you think you have menopause symptoms and want to know your options (NHS)
- you're on HRT and your symptoms aren't well controlled, or you have side effects
- you have any vaginal bleeding after menopause, or a big change in your bleeding pattern (NHS)
Not sure whether your symptoms are menopause-related? Try our perimenopause checklist, or read our guide to perimenopause symptoms.
Honest FAQs
How much is the HRT prepayment certificate?
It costs £19.80 and lasts 12 months, the same as two single prescription charges (NHSBSA). Check the NHSBSA website for the current price, as charges can change.
Who is exempt from HRT prescription charges?
In England, people aged 60 or over, under 16, or 16–18 in full-time education, plus anyone with a valid maternity or medical exemption certificate, an HC2 certificate, a war pension exemption certificate, or who gets qualifying benefits (NHSBSA). Everyone in Wales, Scotland and Northern Ireland pays nothing for prescriptions (House of Commons Library).
Can I backdate an HRT PPC?
Yes, by up to one calendar month from the date you buy it. If you've paid for HRT items in that time, you'll need an FP57 refund receipt to claim the money back within three months (NHSBSA).
Does the HRT PPC cover vaginal HRT?
Several vaginal HRT medicines, including pessaries and creams, are on the list. Check the NHSBSA list for your specific medicine (NHSBSA list).
Do I need an HRT PPC in Scotland or Wales?
No. NHS prescriptions are free in Scotland, Wales and Northern Ireland (House of Commons Library).
Do I need one if I'm over 60?
No. In England, people aged 60 and over get free NHS prescriptions automatically (NHSBSA).
This article is general information, not medical advice. Always speak to a qualified clinician about your own symptoms.
