HRT supply: what are the problems and how are they solved?

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Women face a shortage of hormone replacement therapy (HRT) supplies amid growing demand for this type of treatment.

Here, the PA news agency looks at the issues:

– What is HRT?

The NHS says HRT is a treatment to relieve symptoms by replacing hormones that are at a low level as you approach menopause.

HRT can help relieve most symptoms of menopause, including hot flashes, night sweats, mood swings, vaginal dryness and reduced libido.

– What is the current supply situation?

The Royal Pharmaceutical Society (RPS) said HRT prescriptions had more than doubled in England over the past five years, from 238,000 in January 2017 to nearly 538,000 in December 2021.

The Department of Health (DH) said demand for HRT had increased dramatically, with a 38% increase in the number of prescription items over the past seven years.

– What is the reason for such an increase in demand?

The DH said there was greater awareness of menopause and greater confidence among GPs in prescribing HRT.

– What was the consequence of this higher demand?

Acute shortages have reportedly driven women to share their prescriptions, some reportedly driven suicidal by the debilitating menopausal symptoms they suffer without medication.

The DH said while most of the 70 HRT products available in the UK remain in good condition, a range of factors, including increased demand, have led to shortages of a limited number of products, including Oestrogel.

– What is the government doing about it?

At the end of April, the government announced that the director general of the vaccines task force, Madelaine McTernan, had been appointed to lead a new task force on the supply of HRT.

Her role will be to identify ways to support the HRT supply chain and address shortages some women face on a limited number of products, DH said.

Health Secretary Sajid Javid said Ms McTernan “will use her excellent skills and expertise to build on the success of the Vaccine Task Force to boost the supply of lifesaving medicines for women across the country”.

The DH also said it was issuing severe shortage protocols (SSPs) to limit the distribution of three high-demand products to ensure women can access the HRT they need.

These are Oestrogel 750 mcg/actuation pump gel, Ovestin 1 mg cream and Premique low dose 0.3 mg/1.5 mg modified release tablets.

The SSPs are due to expire on July 29 and are intended to allow community pharmacists to dispense the three specified HRT products according to the protocol rather than the written prescription, without needing to seek permission from the prescriber.

The DH said this would “even out” the distribution of in-demand products such as Estrogel.

– What is the HRT working group responsible for?

The government said the task force will engage with HRT suppliers to ensure there is a good understanding of supply constraints and what is or can be done to address them in the short and long term.

It will also work with the NHS Business Services Authority to secure access to real-time THS distribution data to improve understanding of supply, demand and the causes of shortages.

The task force will also need to engage with professional bodies including the Royal College of General Practitioners, the Royal College of Obstetricians and Gynecologists and the Pharmaceutical Services Negotiating Committee to help pharmacists and prescribers ensure that they respond appropriately to increased demand.

– What about prescription fees?

The DH said it was taking action to increase access and reduce the cost of HRT by allowing women to pay a one-time charge equivalent to two one-time prescription fees, currently £18.70, for all their HRT prescriptions HRT for a year.

Known as a prepayment certificate, it is intended to allow women to access HRT on a monthly basis, easing pressure on supply, while keeping the cost of HRT low. This system will be implemented from April 2023.

– Is it early enough?

Not according to the RPS, who called the timeline “disappointing.”

Thorrun Govind, chairman of RPS England, said: “Delaying this decision will frustrate many who are already paying for monthly HRT prescriptions and will exacerbate the health inequalities already suffered by women across the country.”

She said HRT prescriptions are “essential” but also “a financial drain during a cost of living crisis” as she called for prescription fees for such treatment to be scrapped entirely in England.

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