AIBU to be enraged about a £100 HRT fine?

[OnlyOneAdda]

Been on HRT for about 18 months ago, so have purchased HRT pre payment certificate. Each time I collect my prescriptions, I am asked to show my certificate as proof of payment.

I have just received a letter from NHS saying according to their records I have falsely claimed for a prescription and I will be fined £100. Have called them and provided my certificate number...turns out that one of the new medications my GP added six months ago isn't covered and I should have paid. The letter explicitly states that being mislead by the pharmacy is not a valid exclude.

WTAF? The pharmacy accepted it as payment. If this item wasn't eligible then they shouldn't have. If I go into a shop that doesn't accept AmEx they tell my at point of payment - they don't send me a £100 fine six months later and tell me I should have known better and used a different card.

If I've pre-paid my HRT then it should cover all fucking HRT. And if an item isn't payable by the means provided at the till then this should be flagged at point of sale!!!

Absolutely fuming 🤬 (and of course like most AIBU posts I actually just want you to agree with me 🤣 so if you think IABU then please scroll on and leave me to my menopausal rage...)

And don't get me started on the fact that men don't have to pay full stop for HRT, sanitary products etc. 🙄

It's incredibly shit that they sell a special prepayment certificate for HRT that doesn't, it seems, cover all HRT or at least all hormones - did your GP tell you they were prescribing something that wouldn't be covered? It sounds like you were only on stuff that was covered when you signed up to the PPC, so their pre-warning stuff wouldn't have been any use - you needed to check each new prescription as it was added, which is a really onerous ask of a busy patient I think.

I would pay the fine because NHSBSA scare me, but I'd be livid in your situation OP. Not necessarily at the pharmacist or the GP, just at the system.

Ha! Love this. I am from Wales originally. Think it's a good strategy!

Bloody hell OP. I didn’t realise this either.

just googled and seen 200,000 people in last year. https://www.chemistanddruggist.co.uk/news/clinical/penalty-warning-over-200k-incorrect-hrt-ppc-claims-7QBT6OG7ZJC4FAZTR4H74TM4BA/

@OnlyOneAdda "To be honest, I'm really surprised that the NHS can prescribe something not licensed? What is the purpose of licensing if they can prescribe whether it is or it isn't?" It seems like prescribing unlicensed medicines is done as an exception, rather than the rule: www.gmc-uk.org/professional-standards/the-professional-standards/good-practice-in-prescribing-and-managing-medicines-and-devices/prescribing-unlicensed-medicines

Shit Im 63 and have free prescriptions. Does this mean my hrt might not have been covered for the last 3 years?

If you have a full PPC then HRT is covered. Although I’m not sure about testosterone. If you only have the HRT PCC then you need to check which individual items are covered.

Pay the prescription fee each time, then this won't ever happen.

For those who don't want to do this, there is a cheaper alternative and it is made very clear that not all meds a covered. So yes, if you want to benefit from the cost savings you do need to abide by the clear rules and do a bit of googling.

She's 63, you get free prescriptions from age 60. For everything. No PPC needed.

Until this thread I didn't remember only some HRT medications are covered by prepayment certificate - and I have one!
I vaguely remember checking when I signed up and my items were covered but if my GP changed my HRT I wouldn't have checked it was still covered. It's really confusing, all HRT medication should be covered.

It's just oestrogen no testosterone.

It's not just oestrogen, it's progesterone as well. And the vaginal cream.

I think this is key. The dr should tell you that it is not licensed for menopause when they prescribe it. You would hope that pharmacy staff would highlight this to you but I suppose they are not responsible, as often they don’t even check certificates just ask if you have them.
Also, I thought that most exceptions now go through automatically as last time I collected my script they told me they could see my exception so didn’t need to ask. Hopefully, this will work for all exceptions in the future.

Op, it may be worth checking how the script was sent to the pharmacy, your GP surgery will be able to tell you whether the Testosterone gel was on a separate prescription . If it wasn’t and what a previous poster has stated is true, that it needs to be in order to take payment (I don’t know if this is true but I can imagine it may be the case as I have some knowledge of prescriptions ), then you can say it was an error and hopefully get the fine cancelled. Just a thought but may work.

I am actually unsure if it is true that the testosterone gel would have to be on a separate prescription in order to take payment. As if this was the case then there would have to be some guideline for GP surgeries to issue HRT items on a seperate prescription just in case patients hold exemption certificates.

I've just gone and paid for my prescription and the pharmacist told me she can challenge it for me when I get the fine as she has a record of when I paid.
By the way the fine is 5 times the cost of the prescription UP TO £100 which is why peoples fines are varying.

Not as far as my pharmacy is concerned, I've just paid one charge for the testosterone that was issued alongside the other HRT

It's 20%, not 5%. 1 in 5.

I got caught out when my certificate expired and the reminder had gone into spam folder. Now I set a reminder in my own calendar every year. Much like driving and parking the system is designed to trip you up - nice little earner innit. Definitely adds to the us and them feeling around government and all ‘public’ services.

I never realised this. I just assumed that free prescriptions started at state pension age. Im surprised the government haven’t tried to change it yet.

I believe it's testosterone that isn't covered by the HRT prepayment cert. It's because it's not licenced for women and prescribed off licence for women at a reduced dose, one tenth of the man's dose.

I would definitely appeal. Maybe something like this ..
Dear ..
I am writing to appeal the penalty charge notice with the reference number above. I have recently spoken to an NHS representative on the phone, who informed me that the fine relates to a prescription for Testosterone, which was added to my medication list approximately six months ago.
I wish to express that this was a genuine and honest mistake. As you can see from your records, I purchased an HRT Prescription Prepayment Certificate and have used it correctly for all other eligible HRT medications. When my doctor added Testosterone to my prescription, I presented my certificate to the pharmacy as usual. The pharmacy processed the transaction and accepted my certificate as a valid form of payment, leading me to believe all items on the prescription were covered.
I was not aware that testosterone, even when prescribed for menopause symptoms, is not covered by the HRT PPC. I mistakenly assumed that since it was prescribed as part of my HRT regime, it would be covered by the certificate specifically for that purpose. My confusion was reinforced by the pharmacy's acceptance of my certificate at the point of sale.
I had no intention of making a false claim. I can assure you there was no wrongful intent or lack of care on my part. This was an oversight caused by the complexity of the exemption rules, combined with a lack of clarification from the pharmacy at the time of collection.
I am more than willing to pay the original outstanding prescription charge for the Testosterone. I kindly request that you use your discretion to waive the penalty charge, as I did not act wrongfully and the error was an honest mistake.
I look forward to your response.

It doesn't put the prices up for everyone - it's a contribution towards the NHS, and doesn't even cover the cost of administering and collecting the charge - that's why Scotland, Wales, and Northern Ireland decided not to bother with it.

Utrogestan 100 pessaries are on the approved list - I looked them up cos that's what I use

Are you neurodiverse? You can appeal the fine, telling them you are an ADHDer. No need for evidence. As an ADHDer I struggled to understand the paperwork around renewal. If I pay monthly it automatically renews. If I pay annually it does not. Lots of people get caught out with this.

I have paid the NHS prescription costs and avoided the fines. Hope this is useful to you.

This is why I pay extra for the prepayment certificate that covers everything. I get testosterone and it’s prescribed ‘off label’. I assume it was this add-on that’s messed it up for you?

You can appeal it. I have a medical exemption catd which had expired by at least a year. (I wasn't aware as had misplaced the card at home, and the condition i have is not curable). I assumed it was indefinate.

I appealed, and the fine was repealed. I only had to pay the equivalent of 1 prescription charge, which at the time was £8 odd.