“The lack of transparency around HRT cost and supply is yet another barrier to menopause treatment”

Disconnected prescribing and medication dispensation pathways are preventing clinicians and patients from accessing vital information about the availability and cost of HRT medication. We need to prioritise the connecting of databases and systems in order to inject transparency into every step of the HRT pathway. 

Around 13 million people in the UK are estimated to be currently menopausal or perimenopausal – a state of physiological transformation often accompanied by debilitating symptoms.

For much of history, people were left to self-manage menopause without medical support. However, in the 1960s a novel treatment called Hormone Replacement Therapy (HRT) was made available. For the first time, menopause symptoms could be successfully controlled, and millions could return to living their lives.

Following recent high-profile awareness campaigns, and an ever-evolving understanding of the condition, public demand for HRT is soaring.

UK prescriptions have doubled in the past five years, but the manufacturing and supply chains have failed to keep pace. As a result, several major HRT products have been in critically short supply – leaving millions of people struggling to access their essential medications.

As summarised by Rose George in the Guardian, “HRT is not a lifestyle choice but a lifesaver”.

However, a chronic lack of transparency in the prescription and dispensation process is making it increasingly difficult for doctors and pharmacists to offer appropriate treatment for menopause symptoms without enduring additional stress, frustration and expense to procure HRT.

It’s key that public health leaders, manufacturers, healthcare providers and pharmacists work together to build the transparent, reliable systems that patients deserve.

Why is transparency around HRT supply levels so important?

When a patient goes to their doctor for their HRT prescription, doctors will typically prescribe one of several different types of medication. However, the doctor and the patient have no way of knowing how easy it will be for the patient to obtain this from a dispensing pharmacy.

This means that a patient might have to travel between several local pharmacies to find one that has been able to obtain stock from their suppliers. This presents an obvious barrier to medication access for those who live in rural areas, those who rely on public transport, or those who are time-poor.

In addition, medication consistency is very important in menopause treatment, and not all types of medication work for every person.

This means that switching between different medications – or taking unplanned breaks – limits the effectiveness of symptom management. What patients really need is a consistent, reliable supply of their prescribed medication.

Why does transparency in pricing matter?

When a patient chooses to use a private healthcare provider to obtain an HRT prescription – even if they still collect the item from an NHS pharmacy – NHS medication pricing protections do not apply.

As a result of fluctuating stock availability and insufficient wholesaler quotas, the costs of obtaining privately prescribed medications can also fluctuate significantly depending on the pharmacy visited.

There is no way for women to check or monitor these costs, meaning that during the current cost of living crisis, many simply can’t afford HRT.

What would a system that works for patients and providers look like?

Whilst there are critical manufacturing and distribution issues in the HRT supply chain, there are key areas of responsibility that can be effectively addressed by pharmacies and system reform.

Investment in better digital integration between the system’s multiple moving parts could transform the HRT prescription and procurement experience for all stakeholders.

Firstly, consider supply chain visibility. If a clinician, when generating a patient’s prescription, was informed by pharmacies regarding the availability and forecasted future availability of the different medications, then they could choose to prescribe an HRT medication that the patient would definitely be able to access.

If the patient has access to an app that offers full visibility of the price and availability of their prescribed medication, they are able to make an informed choice.

With the right integrations and digital infrastructure, a more connected, transparent ecosystem could become reality. This would be an ecosystem that would empower women, their doctors, and their pharmacists with reliable and affordable access to HRT medication.

Katie Beaton is the head of product at the London-based digital pharmacy, Phlo.