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. 🙄

Some are prescribed 'off licence'. Testosterone is not licenced because there has not been a study of it, which is ridiculous. Women don't matter/misogyny in the health service.

All pharmacists should know what is covered and what is not though as its literally their job. Mine knows but forgot to tell me I needed to pay so I'll end up with this fine too no doubt.

Aaaaarrrggghh just wasted almost another hour in Boots trying to resolve this and getting computer-says-no response.

Anybody on here that has said their pharmacy fixed the problem - were any of them by any chance a Boots branch and if so would you please be able to share which branch?

No @OnlyOneAdda the outcome will still be the same for you as it is for everyone else.

Whatever you think is right in this situation, the rules are that it’s the patient’s responsibility to check that their medication is covered.
The rules also explicitly state that the pharmacist is not responsible. There’s no reason why the rules should be different for you.

Your situation isn’t special in any way. It’s exactly the same as for any chancer who deliberately collects a prescription without a valid certificate and then claims that they didn’t know/it’s the pharmacists fault.

In my case the pharmacy was much more at fault than in yours and I still had to pay the fine.

Plus stop saying the fine is £100, it’s not it’s £50. And you and the rest of us will save a whole lot more than that in a year with an hrt ppc. If you don’t get on with paying it it will go up to £100.

Many people on this thread have indicated this has been resolved very quickly and easily by their pharmacy, so very happy for the outcome to be "the same as everyone else.". And it is those individuals I asked - if I'd wanted sanctimonious preaching @ForCraftyWriter of course I would have come directly to you.

"The rules also explicitly state that the pharmacist is not responsible." The rules ALSO state (as I have done some research into this as a result of my letter) that I should have signed the pictured declaration and that a pharmacist may do so on my behalf but ONLY with my consent. I've never in the 2+ years I've been on HRT been shown this form or signed such a declaration. I've certainly never given a pharmacist my consent to sign on my behalf - why the hell would I do that? I'm standing right there with use of my right hand? What kind of batshit process is that (one that only the NHS could come up with clearly) "we need you to sign this declaration, but don't worry I'll do it for you, and don't worry to read it - actually I won't even mention it or show it to you but by the way you will be held liable for whatever I sign on your behalf..."

The letter I have been sent (they have not issued a fine yet) states that I will be fined £100. If you're saying the actual fine will be parking fine style ie. it's only 50% if paid sooner I am sure you're right (because obviously you're right about everything 🙄) but I have posted based on the information I have currently, as I already clarified when you went off on one about this originally.

In no way is this the same as somebody deliberately claiming when they know they don't have a certificate (wilfully and intentionally committing fraud) and if you think that's the case then you're a fucking idiot.

I absolutely will challenging this ridiculous process and I give no fucks what you think about that or me.

I had a situation with NHSBSA fining me after getting married - because the name on the full PPC certificate and the prescription did not match!! We had double barrelled our surnames on marrying and the GP updated the system so my next prescription, for 11 items, was in my married name not my maiden name (Mrs No-one’s-Dead instead of Ms No-one’s); the other names, Dob, address etc were all exactly the same; but the person on the helpline told me it has to match exactly or they reject it as being invalid and issue a fine for a false exemption declaration. I would have had to pay the cost of each of the 11 drugs and the fine (almost £150 even back when it happened in 2015!) if they had not accepted me sending in a certified copy of my marriage certificate for them to confirm I was the same person!’

@OnlyOneAdda for sure challenge it and 💯 best of luck...

but at the same time regardless of how nuanced and shit the system is (and everyone agrees its crazy testosterone is not on the approved list... ) there are rules around this and you took this "contract" out.

However maybe you have found your T&Cs different to ours.

If not you then who? And you cant blame a bureaucratic system- it is in place with rules regardless of how crap. You need to drill down and figure out given the rules that we sign up for WHO (an actual person that is not you) is in the wrong

Best of luck and stop with the angry posts at folk who suggest its you!

If I had signed the declaration I would agree with you - crap that testosterone is not included? Yep. Ridiculous to expect the patient to manually look up their meds on a long list or be caught out? Yep. Generally shocking treatment and support for HRT from the NHS? Yep, yep, yep. But thems the rules...I hear you.

What I actually take issue with having dug into the details, is that I am being fined due to a declaration I have not signed, did not give consent to be signed on my behalf, and did not even see / read.

I am fortunate enough to have been in relative good health for most of my adult life, and to have had private medical cover so occasional prescriptions I have filled and paid for privately. NHS prescriptions have only been on my radar for the last 2-3yrs. So this claim form that has now come to light is news to me.

Clearly all patients should sign it - and yes, it's crystal clear. I have never been shown this or signed it. I suspect (and I've actually submitted a FOI request to see if I am right) that pharmacists are routinely signing on behalf of patients without showing them the form or getting their consent. And they should not be. There would be a very small percentage of patients that truly needed a pharmacist to sign for them - it shouldn't be happening as a matter of course. And a process that allows a pharmacist to declare on the patients behalf, and without even their knowledge, but then absolves the pharmacist from any responsibility - that should be challenged.

I went to collect a prescription, I answered truthfully all questions asked, and was told on that basis no money was due and was given nothing to read and sign.

The "angry posts" are in response to somebody telling me I've lied about the fine amount when I have not, and has told me that I'm exactly the same as somebody who deliberately makes a fraudulent claim. Yep, that has PMO, and her sanctimonious, goading tone only fanned the flames. Won't be stopping with those replies sorry 🤷‍♂️

Sorry, prev post was supposed to be in reply to you...

@OnlyOneAdda ok i didnt realise you were now looking at the actual signing (or lack of) of the script at the pharmacist counter and thats what the fine is based on (eg) accusing you of signing and "cheating"

Good luck then and hope that if thats the case it gets resolved..

However it is our responsibility regardless of how awful a system is to know what's covered/ know when you are adding a drug to check.

However well done for finding the technicality

Good thread to highlight the inept way this is done!

Maybe others are confused as to your new angle hence in your words the "sanctimonious" replies. And then that circles back to the poor system in place ... to hard to underatand!

Do update and educate further when its been resolved.

Totally on your side OP. I’ve had the HRT pre-payment cert since they started doing it. I probably checked my meds were eligible at the time, possibly not. If my prescription changed I wouldn’t think to check if it was eligible, I didn’t even remember there was a list to check it against. I just thought it was all HRT.

@darkrootsblue the op agreed that in that case she would be in the wrong IF she signed the script. She didnt hence she is going to tell them they cant fine her as she never "signed and cheated"

Again you need to know what you signed up for the terms and conditions and take responsibility. I dont think the t&c on the contract will let you find blame with the dr or the pharmacist...

And again to stress you cant say you dont think the op should not be fined as something was added and the system was bad

Op has the perseverance to figure out what the issue was to essentially get the fine taken away.

Im sure many of us would sign the script though... and then we have to take the fine (and we cant blame the system being at fault... it is what it is.. and need to abide by the rules) we can complain about it 💯 and feel sympathy that we missed something but we cant absolve ourselves of blame.

There are now a few different issues in this thread

It's a penalty charge not a fine,you won't be taken to court. I wonder if anyone who does this as a one off actually gets it taken any further or do they just go after the repeat offenders?

I've only just read the last couple of posts, not the whole bread. But I knew that certain meds are not covered by the HRT prepayment. It's very clear. Testosterone is not covered, it's not part of the normal HRT regime.

As an aside, if we were paying for the full cost of this privately, it would be hundreds per year. I'm pretty happy to get it all for a lot less!

Are you now trying to say @OnlyOneAdda that if presented with the green slip you wouldn’t have signed to say you have an hrt prepayment for this drug and would instead have paid for it?

And you’re also trying to say that you never mentioned or discussed or confirmed at the counter that you have an hrt prepayment cert in relation to the prescriptions you were collecting?

And yes the fine will come through for £50 like a parking ticket. And I’m sure that in the end you will have to pay it since the rules are the rules and you were made aware of them when you took the discounted certificate out.

@ForCraftyWriter:
What I'm saying is I wasn't given this form and I didn't sign it. I've never been given this form before or signed one when collecting any prescription. I've never been asked to. I've only become aware it exists as a result of my emails with the NHSBSA.

My prescriptions are delivered electronically to the pharmacy, when I have gone to collect I have been asked if I have a PPC, I have shown my HRT PPC, confirmed my address and taken the prescription.

I can't say for certain what I would or would not have done as that is hypothetical. But having now seen the form it certainly would have provided a much clearer prompt for me to check than the conversation I had with the pharmacist which let me to draw the conclusion that HRT PPC was a valid payment method. Which presumably is just one of many valid reasons why it exists in the first place.

And if the rules are the rules, then this form should be signed by the patient, and the pharmacist should only do so with the patients consent. A patient cannot consent to something they don't know exists.

It seems to me (given I have never been asked to sign this and have collected prescriptions from three different pharmacies) that pharmacists are routinely signing this declaration without the patient's consent as it is more convenient for them - but they shouldn't be.

I do very much hope for your sake though that I have to pay the fine as clearly this will bring you great joy. We all have to get our kicks somewhere I guess.

I’m torn between wondering whether you’re having fun at our expense or whether people who are as entitled you really do exist.

Thoughts and prayers.

I'm not in the least bit torn about what I think of you.

The form is the reverse of the prescription. It's not visible if you get electronic scripts though, so you're right there is a flaw in the process.

I can't see an option on the one you've posted for HRT PPC anyway. I would be stuck there with which to tick.

My pharmacy just asks to see the PPC.

When I did have paper scripts, I always signed them, though pharmacists seemed surprised by this. That was pre having a PPC. They seemed to think you only had to sign for free scripts, but it looks as if you have to sign whatever.

I haven't signed a form in years, or indeed had a physical prepayment certificate. Do they send them out for HRT only certificates? When it renews I check it online to ensure it remains valid. The pharmacy I use has the PPC on my record, so they don't even ask.

With regards to your specific queries. A Dr can prescribe “off license” if they believe that it is appropriate for that patient (which should be based on evidence, not whim) but in doing so they are taking a risk that if something untoward happens, that the prescriber may be held responsible for that in a way they would not if a patient had come to harm from use of a licensed medication used appropriately for that patient (i.e no contra-indication to it’s use, used at a safe dose, no interactions with other medications etc). The prescribing doctor should, however, tell the patient that they are prescribing off license.

With regards testosterone as HRT- the rules on its prescription varies. In Scotland for instance, the decision has been made that GPs cannot prescribe testosterone as part of HRT without it having been initiated by specialists. In some areas, they are allowing it for low libido only- the reason given for this is to do with evidence and licensing. The fact is that, currently, the evidence relating to testosterone use in HRT has only so far proven (to the required standard) that it is effective to some degree to address low libido. There is evidence, but not yet deemed definitive, that it works for brain fog, fatigue etc too. My friend who is a menopause consultant- not currently NHS- is very clear on this- she believes it does aid with memory, mood, energy levels etc for a subset of women, but is not appropriate for all- and that we have not yet got really robust evidence to prove it, nor are we good at anticipating who they are. She agrees that the evidence we have currently is only conclusive in terms of effectiveness for low libido related to menopause. It’s not my area of expertise, and she has worked in a number of other countries (currently in Norway and previously Germany), so it’s not all just the NHS ignoring good evidence. I’m also not saying “no evidence”.

Despite what you think, that isn’t the NHS deciding a man getting to have sex is more important than anything else, it is because when something is being paid for the system we have set up is that the evidence has to suggest it is both clinically effective and cost effective. There are a lot of arguments about what constitutes “cost effectiveness’ and where that line should be drawn- and indeed whether we have that set at the right place at the minute. Additionally, the lack of evidence is almost certainly partly due to historical and (perhaps to a marginally lesser degree) current lack of research relating to peri-menopause and menopause.

Call your local MP and flag this. It's an unreasonable burden on patients, some of whom might be dyslexic, or not have access to online information, or may not be lluent speakers of English, or may have difficulty identifying slight differences in spellings of different medications.

And that is apart altogether separate from the question of why medications or substances that a NHS doctor prescribes to a NHS patient (i.e. not a private patient) are not covered - some HRT regimens include testosterone or other additional elements, and all should be covered.

Is it just me or does it sound as if you're rubbing your hands together in glee about this?

Yes I will take this to my MP - I have written to her previously about total different topics and she's always very good about responding, contacting the relevant minister etc so hopeful.

I am waiting for a copy the actual prescription in question which NHSBSA have said they will send in the post and will take 10 days... 🙄

@mathanxiety

Is it just me or does it sound as if you're rubbing your hands together in glee about this?

Certainly sounded that way to me. Every post from her has been goady like this. Some people just delight in pissing on other peoples chips.

Oh how annoying, I wouldn't have realised this had you not mentioned. I have a full certificate atm as have other medications too, but I had assumed if I came off those others that I might switch to the HRT only kind. I don't think I'd have realised this either re the gel.
Especially given the pharmacist didn't say!