Which certificate covers medicines besides HRT?

The wider prepayment certificate takes in NHS prescriptions as a group. The HRT certificate is limited to listed menopause hormones, for the year you buy.

Does Medicare pay for an HRT patch on every plan?

Payment follows the list published by the Part D plan you joined. That plan can also ask for approval before the pharmacy fills it, or limit how much you can collect.

Does a plan treat a compounded hormone cream the same as an approved hormone?

A compounded cream is mixed for one person, and the FDA has not approved that mix. Medica, in one insurer policy, does not pay for those mixes. An approved tablet, patch or gel is judged on the list for the plan you hold.

What do you pay for HRT when no US plan is involved?

In England, the item charge in the opening applies once for each medicine, unless an exemption or a certificate applies. Scotland and Wales waive the NHS prescription charge. A US bill follows the tier on your own plan.

Hormone therapy

Does insurance cover HRT?

In England the NHS charges £9.90 for each prescribed item unless you are exempt, and an HRT prescription prepayment certificate costs £19.80 for 12 months. In the US, a plan covers the medicine only when it is on the drug list for that plan, and Medicare.gov does not name menopause hormones as a benefit on every Part D plan.

By Ines Kovac. Published 19 October 2026. 6 minute read.

Summarize with:

Several silver blister packs of white, pink, yellow and dark red tablets and capsules overlap on a wooden table.

Will insurance cover HRT?

NHS prescriptions in Scotland and Wales are free (NHSBSA: help with NHS prescription costs). The HRT certificate is for patients in England, which is where that item charge applies (NHSBSA guidance on the HRT certificate).

In the United States, whether insurance will cover hormone replacement therapy depends on the plan you hold. Employer health plans and Marketplace plans include a prescription benefit, and each plan chooses which medicines it covers. Medicare Part D is built the same way. Each plan has its own list of covered drugs, and the Medicare page that explains those lists does not name menopause hormones as something every plan includes (Medicare: how drug plans work).

A GP in England can prescribe HRT to help relieve menopause symptoms, after a discussion of whether it suits you. What you pay at the pharmacy then follows the usual NHS rules (NHS: about HRT). The guide to HRT for menopause covers patches, gel and tablets, and when a progestogen is added to oestrogen.

How much does HRT cost on the NHS in England?

The NHS prescription charge in England applies to each prescribed medicine or appliance. It is per item, not per prescription form (NHS: prescription charges). On 28 April 2025 the government kept that charge at its existing amount and left the exemptions as they were (GOV.UK: prescription charges frozen).

You are entitled to free NHS prescriptions in England if you are aged 60 or over (NHSBSA: free NHS prescriptions). The same NHSBSA page lists the other groups who qualify.

Oestrogen and a progestogen are often two separate medicines. Each one is its own item, so one trip to the pharmacy can mean two charges. An exemption or a prepayment certificate removes those charges.

The HRT prescription prepayment certificate

That HRT certificate is valid for 12 months. Across those months it covers an unlimited number of certain HRT medicines (NHSBSA page for the HRT certificate).

You save money if you pay for more than two qualifying items in a year (government page: get an HRT certificate). That is the test for whether this certificate is worth buying.

Every medicine it covers has to be an HRT medicine licensed in the UK to treat the menopause. A GP can still prescribe an HRT product that is not on that list. Those items are charged at the usual rate (NHSBSA: medicines covered by the HRT PPC). Match the name on your prescription, brand or generic, to that live list before you pay.

A standard prepayment certificate is the wider option when you also collect other NHS medicines. A 3-month certificate costs £32.05 and a 12-month certificate costs £114.50 (NHS: save money with a PPC). Either one covers all NHS prescriptions. If the only items you pay for are listed menopause hormones, the two-item test above is the comparison that matters. If you also pay for other NHS prescriptions, compare a year of those separate charges with that 12-month certificate and choose the lower total.

US plans and Medicare Part D

All Marketplace plans cover prescription drugs. That benefit is one of the ten essential health benefits (HealthCare.gov: what Marketplace plans cover). Each plan decides which medicines it will pay for.

Before you enroll, check the list, or the Summary of Benefits and Coverage, so you can see whether your prescription is included (HealthCare.gov: prescription medications). If a plan does not cover the drug, you can ask for an exception. When the plan agrees, it generally treats the drug as covered and applies its usual cost sharing.

Medicare pays for a patch, gel or tablet when your Part D plan lists that product. Plans may require prior authorization before you can fill certain prescriptions. They may also use step therapy or a quantity limit. For a drug that is off the list, you can request an exception, and your prescriber can support the request (Medicare: plan rules).

A 2025 guide from the Society for Women's Health Research says the delivery method can change how fully a plan pays for hormone therapy. Out-of-pocket costs depend on the tier and the pharmacy (SWHR: utilizing menopause coverage, 2025). That guide gives no single national amount.

Compounded and bioidentical HRT

A hormone the FDA has approved for menopause can be included on a plan's drug list. A compounded product is mixed for one person. The FDA states that compounded drugs are not FDA-approved, and that they are not verified for safety, effectiveness or quality before they are sold (FDA: compounding questions and answers).

The FDA recommends hormone therapies it has evaluated for safety and effectiveness. Many products sold as compounded bioidentical hormones fall outside that group (FDA: menopause).

ACOG says compounded bioidentical menopausal hormone therapy should not be prescribed routinely when an approved formulation exists (ACOG clinical consensus, 2023).

Some insurers write that split into their own policies. Medica's coverage policy is one example, from a single insurer. That policy does not cover compounded bio-identical hormone products or the medical services tied to them. An approved hormone can still be covered under the pharmacy benefit when that plan lists it (Medica: bioidentical hormone coverage policy).

Regulated body-identical prescriptions and compounded mixes are easy to confuse. The article on bioidentical hormones sets out how a regulated prescription differs from a compounded mix.

What to do before you fill a prescription

In England, read the NHSBSA page on free prescriptions, then the list of medicines the HRT certificate covers. If you also collect other NHS prescriptions, compare a year of item charges with the 12-month certificate price in the section above.

In the US, open your plan's list or ask the insurer for the tier, and ask whether prior authorization applies. If the plan denies coverage, ask for an exception and ask your prescriber to support it. If that request is declined, ask whether a listed form would be suitable.

Take a written symptom record to the GP. The menopause symptom checklist for your GP is built for that appointment. When periods stop before 45, the early menopause article explains how long treatment usually continues, and prescription charges in England still apply to those prescriptions. The risks article sets out extra cases of breast cancer, clots and stroke per 1,000 women. The rest of the HRT guides are on the hormone therapy hub.

My take

I would start with the two-item test in England. If oestrogen and progestogen will mean more than two charges in the year, I would buy the HRT certificate. On a US plan I would judge the yearly cost by the tier each medicine is given. A low tier on one hormone and a high tier on the other changes that total.

Sources

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