The HRT prepayment certificate is the cheapest thing the NHSBSA sells and the one most likely to be mis-sold to yourself. It costs £19.80 and lasts twelve months. For a lot of women that is a genuinely excellent deal. For a smaller group it is £19.80 spent on the wrong certificate, because a standard prepayment certificate would have covered everything instead of one category.
Here is what it covers, what it does not, and how to work out which one you actually need. This is general information about NHS charges, not medical advice about HRT itself, which is a conversation for your GP or menopause clinic.
What It Costs and How Long It Lasts
The HRT PPC costs £19.80, which is deliberately set at the price of two single prescription items at the current £9.90 charge. It runs for 12 months from its start date, and during that time it covers an unlimited number of the HRT medicines on the list, no matter how many times you collect them.
There is no three-month version and no Direct Debit. It is a single payment of £19.80, once a year.
The Sum Is Almost Insultingly Simple
Two items a year and you have broken even. Anything after that is free.
In practice most women on HRT are collecting far more than two items a year, because HRT is usually dispensed in one-month or three-month quantities and often as more than one product. Take a common pattern: an oestrogen gel or patch plus a progestogen, collected every three months. That is eight items a year, which at £9.90 comes to £79.20. With the certificate it is £19.80. You are £59.40 better off.
On a monthly collection of two products, it is 24 items a year, £237.60 without the certificate against £19.80 with it.
The one thing that catches people out: each product on a prescription is a separate item. Oestrogen and progestogen prescribed together on one form are two items, not one. Most people undercount, which means most people underestimate how much the certificate is saving them.
It Does Not Cover Every HRT Medicine
This is the part worth reading twice. The certificate covers listed HRT medicines, and the definitive list sits in Part XVI of the Drug Tariff, which is updated periodically. It is not simply "anything your menopause clinic prescribes".
The clearest example of an exclusion is testosterone gel, which is prescribed off-licence for some women alongside HRT. Testosterone is not licensed in the UK for treating menopause symptoms, so testosterone products fall outside the certificate. If that is part of your regime, you will still be charged £9.90 for it each time, on top of holding the HRT PPC.
If you are unsure whether a specific product is on the list, ask your pharmacist before you buy the certificate. They deal with the endorsement side of this and can check the current Tariff, which is a far better answer than the one you will get from a forum.
Do not assume, check. The certificate only helps with the items on the list. If your prescription includes something outside it, you keep paying for that item at the standard charge, and the standard PPC may be the better buy.
HRT PPC or a Standard PPC?
The honest answer depends entirely on what else you are prescribed.
| Your situation | Better option | Cost for 12 months |
|---|---|---|
| HRT only, nothing else prescribed | HRT PPC | £19.80 |
| HRT plus one other regular item | Usually the 12-month PPC | £114.50 |
| HRT plus occasional one-off items | HRT PPC, pay for the odd item | £19.80 plus £9.90 an item |
| HRT plus testosterone only | Compare both, see below | Varies |
| Entitled to free prescriptions | Neither, buy nothing | £0 |
That fourth row is the awkward one. Say you hold an HRT PPC at £19.80 and pay separately for monthly testosterone: that is £19.80 plus twelve items at £9.90, so £138.60. A 12-month standard PPC covering everything is £114.50. In that case the standard certificate wins, and you would not buy the HRT one at all.
If the testosterone is dispensed in three-month quantities, four items a year, the HRT PPC route is £19.80 plus £39.60, which is £59.40 and comfortably cheaper. So it turns on how often you actually collect, not on how many products are on the list.
Our prescription calculator will run your own item count against both certificates if you would rather not do it on paper.
Check You Are Not Already Exempt First
Before buying anything, check whether you get free prescriptions anyway. Anyone aged 60 or over gets them free in England, which covers a substantial share of HRT users, and a great many women hold a valid medical exemption certificate for an unrelated condition without connecting it to their HRT.
An exemption covers everything, including HRT, and buying a certificate on top of it is money thrown away. Our eligibility checklist goes through every category, and the NHSBSA has an online checker if you would rather answer the questions than read the list.
England Only
Prescription charges were abolished in Wales in 2007, Northern Ireland in 2010 and Scotland in 2011. If you live in any of those three nations you pay nothing for HRT and there is no certificate to buy. The HRT PPC is an England-only product because England is the only part of the UK still charging.
How to Buy One
Online through the NHSBSA is the fastest route. You pay by card, and the certificate is issued to you by email, which you can download or print. Some pharmacies can also sell you one over the counter, though not all of them are set up for it, so ring ahead rather than making a special trip.
Keep the certificate number somewhere you will find it. Pharmacies check electronically in most cases, but having the number on your phone removes any argument at the counter.
Timing, Backdating and Refunds
Think about the start date rather than accepting the default. If you know a prescription is due next week, there is no advantage in starting the certificate today and losing a week at the far end.
If you have already paid for HRT items recently, the refund route matters. You have to ask for the FP57 receipt form at the moment you pay at the pharmacy. It cannot be issued later, and without it there is nothing to claim against. With one, a refund claim has to be made within three months less a day of the date you paid.
And if your circumstances change mid-certificate, for instance you turn 60 or you are issued a medical exemption certificate, you may be able to claim a refund on the unused part rather than simply letting it run out. Refund requests of that kind need to go in within three months of the entitlement arising.
Renewing
It does not renew itself. Twelve months after the start date it stops, and the next prescription is charged at £9.90 an item unless you have bought a new one.
Set a reminder for eleven months rather than twelve. Presenting an expired certificate is treated the same as claiming an exemption you are not entitled to, and that means the original charge plus a penalty on top. It is an avoidable and slightly humiliating way to lose money on the cheapest certificate the NHS sells.