The Government's new proposal to make hormone replacement therapies (HRT) cheaper and easier to access could be a ‘nightmare’ for pharmacy teams if not implemented correctly, some of the pharmacy sector has warned.
Last week, the Government announced it would work with NHS England to look at implementing longer prescribing cycles, in line with NICE guidelines, to reduce the need to pay frequent prescription charges.
If this change is implemented, women could only have to pay one charge every 12 months, saving up to £205 a year.
Ben Merriman, a practice and hospital pharmacist in Cumbria, told The Pharmacist last week (29 October) that the Government was right to look into the costs of HRT for women.
As it stands, a prescription for HRT costs £9.35 – or £18.70 if a woman needs two types of hormones. This is often only provided by GPs on a short-term basis, which means that the cost has to be paid regularly, once a month or every three months.
However, Mr Merriman said he was concerned about how the new Government policy would be implemented and how it could impact pharmacy financially and in terms of workload.
‘I cannot see an easy way of implementing the method proposed whereby women will only pay once per year — one charge for an oestrogen-only or continuous combined product and two charges for a cyclical combined product),’ he said.
‘No other items prescribed on the NHS have such a charging system, meaning the way NHS Business Services Authority process prescriptions and the way pharmacies would collect the Rx charge would need a massive overhaul.
‘GPs could prescribe a year of the HRT at a time, but this may not be appropriate for certain individuals. It would also impact pharmacies as there would be a reduction in dispensing fees and it could destabilise supply of these medicines, medicines which have had a very temperamental supply in the not too distant past,’ he added.
Another pharmacist took to Twitter to express similar concerns about how the Government policy could affect the sector.
Chris Armstrong, a community clinical pharmacist, tweeted that it would be a ‘total nightmare for pharmacy, especially regarding the shortage of HRT in the supply chain’.
When asked whether wholesalers could deal with a potential increase in demand for HRT medications, Martin Sawer, executive director of the Healthcare Distribution Association (HDA), told The Pharmacist he expected HRT supply issues to be ‘better monitored’ going forward.
‘Most HRT products only go through three wholesalers in the UK so that will be quite well monitored by the Government.’
Until recently, HRT was distributed through several wholesalers which made tracking supply issues more difficult.
‘As long as the manufacturing side does not have the issues it had before, it should all go quite well.’
Alliance Healthcare — one of the three wholesalers that provide HRT to pharmacies in the UK — told The Pharmacist: ‘We are waiting for further details on how the change will be implemented and will work with manufacturer partners to give patients access to available stock.’
Phoenix and AAH — who also supply HRT to UK pharmacies — have also been approached for comment.
Thorrun Govind, chair of the English Pharmacy board at the Royal Pharmaceutical Society (RPS) also raised concerns over how the policy might be achieved and what negative consequences it could have.
‘Tinkering with a broken system is not the way forward and risks introducing a range of unintended consequences such as shortages of HRT and increased wastage. A proper review of any proposals must take place before they are introduced, and the pharmacy profession must be closely involved.’
She also called on the Government to ‘go further to tackle the health inequalities experienced by women across Great Britain.
‘Any moves to support women’s health are to be welcomed. However, [the news] about reducing the cost of prescriptions for HRT for menopausal women does not go far enough.
‘The Government must go further and scrap prescription charges in England altogether, as is already the case in Scotland and Wales. Taxing those that are in vital need of healthcare support is unacceptable.’
Similarly, Leyla Hannbeck, chief executive officer of the Association of Independent Multiple Pharmacies (AIMp) said that cutting charges for HRT is ‘step in the right direction but it does not go far enough.’
She added: ‘The sooner we stop charging for all prescriptions and simplify the system so that we reduce the administrative burden on pharmacists allowing them to spend more time with patients, providing additional services and alleviating the pressures elsewhere in the NHS the better.'
In September, health bodies and charities urged ministers to reconsider the Government’s proposal to scrap free prescriptions for patients aged 60-66 to prevent exacerbating health inequalities and additional costs to local health services.
This came after the Government launched a consultation in July on whether to raise the minimum age for free prescriptions in England, to help the NHS claw back the money it lost from the pandemic.