Understanding prescriptions for menopause treatment: private, NHS and HRT prepayment certificate savings explained

Dr Jacqueline Radley

Sep 6

12 min read

Updated: Sep 10

Prescriptions can feel complicated, especially when you're navigating both private and NHS care. This guide explains everything clearly, so you know exactly what to expect and how to keep costs as manageable as possible.

When you see a private menopause specialist, one of the most practical questions is: how do prescriptions actually work? Will you be paying private prices for everything? Can your prescriptions continue on the NHS? And is there anything that can reduce the cost of ongoing prescriptions?

The good news is that there is a lot of flexibility in the system, and with the right information you can make choices that suit both your health needs and your budget.

In this guide, you'll discover:

private prescriptions for HRT: what they are, how they work, and costs involved
how many women can continue their prescriptions on the NHS
how the NHS prepayment certificate scheme can save you money on ongoing HRT

Part one: private prescriptions

What is a private prescription?

When you are seen by a private specialist, any medication prescribed by them is issued on a private prescription rather than an NHS one. This is simply a prescription written outside of the NHS system. It can be taken to most pharmacies, or fulfilled through an online pharmacy.

Private prescriptions are not subject to the standard NHS prescription charge. Instead, you pay the actual cost of the medication, which varies depending on what is prescribed. For some medications this can be very reasonable; for others, particularly newer or less commonly prescribed treatments, it may be higher.

Not every woman who sees me privately will need a private prescription – in many straightforward cases, your GP can prescribe your HRT directly following my recommendation (covered in part two). But where a private prescription is needed, here is how it works.

How prescriptions work in my practice

When I prescribe medication during a consultation, I use CloudRx, a regulated online pharmacy. A payment link is sent to you immediately after your appointment, and in most cases your medication is delivered the next working day, so there is no need to visit a pharmacy or wait for a paper prescription.

When a prescription is issued as part of a consultation, you pay only for the cost of the medication itself; there is no additional dispensing fee.

If you need a repeat prescription outside of a scheduled appointment, there is an additional charge of £35. This covers the clinical review of your request, the writing of the prescription, and any correspondence required. It is separate from the cost of the medication itself. This charge only applies to private repeat prescriptions; it does not apply if your GP is prescribing your HRT on the NHS (covered in part two).

What medications might be prescribed privately?

For most women, the HRT I prescribe is identical to what would be prescribed on the NHS. The private route simply offers faster access, more time to discuss your individual needs, and a more personalised plan.

There are a few medications that are more likely to require a private prescription on an ongoing basis:

Testosterone is sometimes recommended alongside HRT for women experiencing persistent reduced libido. The only testosterone product licensed specifically for women in the UK, AndroFeme cream, is not available on the NHS, so it can only be prescribed privately. On the NHS, testosterone products licensed for men are prescribed ‘off-licence’ at lower doses suitable for women. Many GPs are happy to continue an NHS testosterone prescription once a specialist has initiated it and you are established and stable on treatment. However, some practices are not able to take it on under their local prescribing guidelines, and some GPs prefer that off-licence prescribing remains with a specialist. In either case, I can continue this privately.

Veoza (fezolinetant) is a non-hormonal medication for hot flushes and night sweats, suitable for women who cannot or prefer not to take hormones. NICE (The National Institute for Health and Care Excellence) has recently approved it for NHS use in women for whom HRT is unsuitable. However, due to this recency, local NHS arrangements for prescribing it are still being put in place, so availability may vary from area to area for a while. In the meantime, I can prescribe it privately where it's appropriate for you. It does require some routine blood tests to check your liver, which I'll explain if we're considering it.

Lynkuet (elinzanetant) is another new non-hormonal option developed to treat ‘vasomotor symptoms’ of menopause: hot flushes and night sweats. It may also reduce sleep disturbance that often occurs as a result of these symptoms. In July 2025, the UK became the first country in the world to approve it. However, it has not yet been appraised by NICE, so it is not currently available on the NHS and can only be prescribed privately for now.

Complex scenarios: If your case is complex or your treatment involves medication that falls outside standard NHS prescribing guidelines, ongoing private prescriptions may be needed. This isn't common, but we'll always discuss it openly during your consultation so there are no surprises.

Non-hormonal treatments

Hormones are not the right choice for every woman. Some women cannot take HRT for medical reasons; others prefer not to. I prescribe a range of non-hormonal treatments where these are appropriate, to help manage symptoms and support overall wellbeing through the menopause transition.

Where non-hormonal medications are available on the NHS, your GP can prescribe these following our consultation in exactly the same way as HRT, keeping your ongoing costs at NHS rates. Some non-hormonal treatments may need to be prescribed privately, depending on availability and individual circumstances. We will discuss all of this as part of your consultation and agree on a plan that works for you.

Part two: continuing your prescriptions on the NHS

Getting your HRT on the NHS

Because standard HRT is routinely available on the NHS, most women do not end up paying privately for their ongoing medication. Whether your GP begins prescribing immediately or takes over after a short period of private prescribing depends on a few things, but the outcome is the same: your long-term HRT is managed through the NHS at NHS cost.

Here are some examples of how the most common scenarios work in practice:

Your GP prescribes from the outset. Where HRT is appropriate and the clinical picture is uncomplicated, my post-consultation letter to your GP acts as a direct recommendation. Your GP can begin prescribing without any interim private prescription, which means the consultation fee is your only private cost. A significant number of my patients take this route.

You collect a short private prescription to get started sooner. Rather than waiting for a GP appointment to initiate the transfer to NHS prescriptions, some women ask me to prescribe their first month privately so they can begin treatment the same week. Your GP then picks up prescribing once my letter arrives. A month of standard HRT on a private prescription – oestrogen gel or patches alongside progesterone – typically costs around £20–25, and from the second month onwards your prescriptions continue at NHS rates.

I manage your prescriptions whilst treatment is adjusted and stabilised. Some women prefer to stay under my prescribing care while we fine-tune dosages and confirm everything is working well. This usually lasts around three months, after which I carry out a review and transfer prescribing to your GP.

Ongoing private prescribing for complex or off-licence treatment. Where your medication falls outside routine NHS prescribing – for example, off-licence preparations or cases requiring closer specialist oversight – I continue to prescribe privately. Your GP may still take over in time, but this is not guaranteed. The specific medications most likely to remain on private prescription are detailed in part one.

After every consultation, you receive a full clinical letter covering your symptoms, medical and family history, the agreed treatment plan, and the reasoning behind each recommendation, and a copy is sent to your GP with your consent. Whether your GP is prescribing from day one or taking over your prescriptions after a period of private prescribing, that letter is designed to give them complete confidence. I keep communication with GP surgeries open and practical, and I always respond promptly when they write back with questions or updates.

Are there any exceptions?

Prescribing decisions always rest with the individual GP practice, but for standard HRT this is rarely an issue: it is routine NHS prescribing, and the detailed letter I provide gives your GP everything they need. There are occasional exceptions. Some local prescribing guidelines restrict particular medicines, particularly those prescribed off-licence, such as testosterone (see part one). Whatever the reason, I can continue to prescribe privately so that you are never left without your medication.

What medications are available on NHS prescription?

The vast majority of HRT, including oestrogen patches, gels, sprays, tablets, progestogens including micronised progesterone (Utrogestan), the hormonal coil, and vaginal oestrogen, is available on NHS prescription and can be managed by your GP following our consultation. This includes body-identical hormones, which are the same preparations I would prescribe privately.

Testosterone, Veoza and Lynkuet are the exceptions covered in part one: testosterone depends on local prescribing guidelines and your GP's judgement about off-licence prescribing, while Veoza and Lynkuet are currently more easily accessed privately.

A note on prescription charges

If your HRT is prescribed on the NHS, you pay the standard NHS prescription charge – currently £9.90 per item (frozen for 2026/27). If you are exempt from prescription charges (see part 3), your NHS prescriptions are free.

It is worth remembering that NHS prescription charges are per item, not per prescription form. If you are prescribed three different HRT items, for example an oestrogen gel, a separate progesterone, and a vaginal oestrogen, each one attracts a separate charge of £9.90.

This is where the NHS prepayment certificate schemes become very useful.

Part three: NHS prepayment certificates

What is a prepayment certificate?

A prepayment certificate (PPC) works like a ‘season ticket’ for NHS prescriptions. Rather than paying £9.90 per item every time, you pay a single upfront fee that covers all qualifying NHS prescription items for a set period, no matter how many you collect. If you take regular medication, it can save you a significant amount over the course of a year.

There are two types of PPC relevant to women on HRT: the standard PPC and the HRT-specific PPC. Both are available in England only. Prescriptions are free in Scotland, Wales, and Northern Ireland.

The HRT prepayment certificate (HRT PPC)

The HRT PPC was introduced in April 2023 specifically to make HRT more affordable, and it provides excellent value for most women on ongoing treatment.

Cost: £19.80 for 12 months (frozen for 2026/27), the equivalent of just two standard prescription charges.

What it covers: An unlimited number of eligible HRT medicines on NHS prescription for 12 months, regardless of how many items you collect or how often.

What the HRT prepayment certificate does not cover:

Testosterone
Veoza (fezolinetant) and Lynkuet (elinzanetant)
Any non-HRT medications (for example, antidepressants, blood pressure medication, or other treatments you may be on)
Privately prescribed medications; the HRT PPC applies to NHS prescriptions only

Who does not need one: Women who are already exempt from prescription charges do not need to purchase a PPC. Prescription charges do not apply if you are:

aged 60 or over
under 16
aged 16 to 18 and in full-time education
pregnant or have given birth in the last 12 months (with a valid maternity exemption certificate)
in possession of a valid medical exemption certificate for a qualifying condition.

Women on certain benefits or low incomes may also qualify for free prescriptions; you can use the NHSBSA eligibility checker here to see if you may qualify for free NHS prescriptions.

How to apply: You can apply online at www.nhsbsa.nhs.uk/hrt-ppc, by phone on 0300 330 2089, or in person at some pharmacies. A digital certificate is sent to your email immediately on application. A paper certificate can take up to 10 working days. The certificate must be paid for in full at the time of application; it cannot be paid by instalments. Show your certificate (digital or paper) to your pharmacist when collecting your prescription.

The eligible medicines list: The HRT PPC covers a wide range of HRT preparations, including most commonly prescribed oestrogen and progesterone treatments. It is worth checking that your specific medication is on the list before applying. The full list is available here.

The standard prepayment certificate (PPC)

The standard PPC covers all NHS prescription items, not just HRT, and is worth considering if you take a number of different medications alongside your HRT.

Current costs (frozen for 2026/27):

3-month PPC: £32.05
12-month PPC: £114.50 (can be paid in 10 monthly instalments by direct debit)

When it makes better sense than the HRT PPC: If you collect a significant number of non-HRT prescription items, the standard PPC may offer better overall value. For example, if you take HRT alongside regular medications for blood pressure, thyroid, or mental health, the cost of those additional items can quickly add up. The standard PPC covers everything in one.

A useful rule of thumb: if you collect more than three prescription items in three months, or more than 11 in a year, a standard 12-month PPC will save you money compared to paying per item.

You can buy a standard PPC online here or by phone on 0300 330 1341. If you are unsure which certificate offers better value for your circumstances, your pharmacist can help you work it out.

Putting it all together: a practical summary of prescriptions for HRT

To help make sense of all the options, here is a straightforward overview of how prescriptions might work depending on your situation:

If your GP prescribes your HRT from the start:

Following my recommendation letter, your GP prescribes your HRT on the NHS. There is no private prescription cost – your only expense is the consultation fee and standard NHS prescription charges (or nothing, if you're exempt). This is the most common path for uncomplicated cases, and with an HRT prepayment certificate can cost as little as £19.80 per year.

If you start on a private prescription to get going quickly:

I issue a private prescription for the first month (typically around £20–25 for standard HRT), and your GP takes over NHS prescribing once they've received my letter. From that point, you pay NHS prescription charges only. This allows you to start treatment as soon as possible following your private consultation, without needing to pay ongoing private prescription charges.

If your ongoing HRT is prescribed on the NHS:

Once your GP has taken over prescribing, you’ll pay NHS prescription charges per item (currently £9.90 each), or nothing if you're exempt. If you collect three or more HRT items per year, buy an HRT PPC for £19.80 and your HRT is effectively covered for the year. If you also take other medications, consider whether a standard PPC offers better value.

If you continue your HRT prescription through me via CloudRx:

This is a private prescription, meaning you will pay the cost of the medication. Repeat prescriptions requested outside of an appointment carry an additional £35 prescribing charge. The HRT PPC and standard PPC do not apply to private prescriptions.

If you are prescribed testosterone:

This is most commonly prescribed privately, at least initially. Once you are established and stable on treatment, many GPs will continue this on the NHS, depending on local prescribing guidelines and their own professional judgement about off-licence prescribing. If yours prefers not to take it on, I can continue to prescribe via CloudRx.

If you are prescribed Veoza (fezolinetant) or Lynkuet (elinzanetant):

Veoza has recently been recommended by NICE for NHS use when HRT is unsuitable, but local NHS prescribing arrangements are still being put in place, so for now it may be quicker to access privately. Lynkuet is awaiting NICE appraisal and is currently available on private prescription only.

A final word

Navigating prescriptions across private and NHS care can feel complicated, but in practice it tends to be straightforward once the initial consultation and plan are in place. For many women, prescriptions can start on the NHS from the outset, and for those who do start on a private prescription, the transition to NHS prescribing is usually smooth and quick, facilitated by the letter I write to your GP after each consultation. Communication with your GP is something I prioritise, as I truly believe the best care comes when we work together.

If you have questions about any of this before booking, please don't hesitate to get in touch. And if ongoing costs are a concern, it is always worth raising during your consultation with me, so we can look at the options together.

Frequently asked questions

Can I continue my HRT on the NHS after seeing a private menopause specialist?

Often, yes. Standard HRT is available on the NHS, and after your consultation Dr Radley writes to your GP with a full recommendation so they have everything they need to take over prescribing. Many women do continue their HRT on the NHS this way. However, prescribing decisions always rest with your own GP practice, so it cannot be guaranteed, and a small number of treatments (such as testosterone) may not be prescribed locally. If a medicine can't be provided on the NHS, Dr Radley can continue it privately so you are never left without it.

How much is the HRT prepayment certificate, and what does it cover?

The HRT prepayment certificate (PPC) costs £19.80 for 12 months and covers an unlimited number of eligible HRT medicines on NHS prescription during that time, however many items you collect. It works like a season ticket for your HRT and is available in England only.

What does the HRT prepayment certificate not cover?

It does not cover testosterone, Veoza (fezolinetant), Lynkuet (elinzanetant), any non-HRT medicines such as antidepressants or blood pressure treatment, or any privately prescribed medication. The HRT PPC applies to NHS prescriptions only.

Should I choose the HRT PPC or the standard prepayment certificate?

If HRT is the main thing you collect, the HRT PPC is usually best value. If you also take several other regular NHS medicines, the standard PPC covers everything in one. As a rule of thumb, if you collect more than 11 prescription items a year, a standard PPC will save you money.

Do I need a prepayment certificate if I'm 60 or over?

No. If you are 60 or over your NHS prescriptions are free, so you do not need a PPC. The same applies if you hold a valid medical exemption certificate, or qualify through pregnancy, low income, or certain benefits.

Why are testosterone, Veoza and Lynkuet sometimes only available privately?

The only testosterone product licensed for women in the UK is not available on the NHS, so it is often prescribed privately, at least until a GP will continue it. Veoza has been recommended by NICE for NHS use when HRT is unsuitable, but local prescribing arrangements are still being put in place, so it can be quicker to access privately for now. Lynkuet has not yet been appraised by NICE, so it is available on private prescription only.