Women force rethink on cost of HRT

Patients have been paying twice for a treatment that is reaping fat profits,Celia Hall reports

IT IS ONE of the biggest pharmaceutical success stories of the decade, providing vast profits for some of the world's most powerful drug companies. Even the National Health Service has benefited financially from hormone replacement therapy. But now, after a successful campaign by women whose lives have been transformed by HRT, the Government has backed down and agreed to consider removing a "baffling" anomaly in prescription- charging which means thousands have to pay twice for the treatment.

HRT enables menopausal women to alleviate some of the most vexing symptoms of their condition, and, longer-term,helps prevent osteoporosis, the bone-weakening condition in elderly women.

About 1.5 million women, or 19 per cent of the eligible UK population, take HRT; five years ago it was about 10 per cent. More than 5.6 million HRT prescriptions were written in the year to March, compared with 2,320,000 in the year to March 1991, according to data from Intercontinental Medical Statistics.

In the UK alone the market is worth pounds 105m.

The prescription anomaly came about because of the way in which the treatment was devised and charges are regulated. HRT involves two types of female hormone drugs, oestrogens and progestogens, and prescription rules mean that women pay a fee for each drug, even though the treatment comes in single packs.

Most doctors prescribe three or six months' supply at a time, although some are prescribing only a month at a time in order to keep their own average prescription costs down, according to HRT campaigners.

Many believe this can detersome women from taking the treatment, because it means the patient has to pay pounds 10.50 instead of the usual pounds 5.25 for each prescription, so women face charges of between pounds 21 and pounds 126 a year for a treatment the Department of Health itself encourages, because of its assistance in the prevention of osteoporosis.

After the menopause, women stop producing oestrogen, which is important for bone mass and also provides protection against heart disease.

To obtain benefit counteringt osteoporosis and heart disease, women need to take HRT for five years. It costs the NHS pounds 750m to treat osteoporosis and the 60,000 hip, 50,000 wrist and 40,000 spine fractures it causes each year.

Earlier this year a Department of Health report on osteoporosis recognised that double pricing "may be a disincentive to taking HRT". Now the department has confirmed that it is looking again at the policy.

Sandra Shulman, aged 55, an author living in north-west London, said she was "utterly baffled" when her pharmacist asked her for pounds 10.50 for a single prescription - the more so because for nearly a year the pharmacist had mistakenly charged her only once, at pounds 5.25.

Ms Shulman, who says she had an "easy" menopause without troublesome symptoms, was prescribed HRT in June last year because she was losing bone density.

"It [the prescription pricing] is completely incomprehensible," she said. "I get one sealed package which contains patches [which deliver oestrogen through the skin] and pills. Neither may be taken except in conjunction with the other, and the whole thing is prescribed as a single treatment."

Ms Shulman was so astounded that she wrote to her MP, Glenda Jackson, about the "grossly unfair" charge. She wrote: "I am sure you will agree that many women not eligible for benefit may find themselves in straitened circumstances where the burden of the additional cost may force them to forgo a recommended treatment."

Ms Jackson agreed that the charge seemed "ludicrous" and had the effect of penalising women who needed the HRT treatment.

She wrote to Stephen Dorrell, the Secretary of State for Health, and received a reply from Gerald Malone, the health minister. Mr Malone wrote that the prescription charge was based on 1968 regulations for prescription charges "re-introduced by the Labour government".

He recommended the prescription season ticket, which allows patients to pay an advance charge of pounds 74.80 to cover all prescriptions in a single year.

Ms Jackson described this reply as disingenuous, as in 1968 the prescription charge was 2s 6d and not pounds 5.25.

Ms Shulman says that the pre-payment system is not a solution to the present problem either, "since it still allows the Department of Health to get away with charging twice for one prescription".

In the UK, HRT is licensed as a menopause treatment only with both hormones, unless a woman has had a hysterectomy. Oestrogen replacement alone can increase a woman's chances of getting womb cancer. The progestogen taken towards the end of each cyle promotes light menstruation, clearing out the womb lining.

Although the number of women taking HRT has grown steadily in the past five years, Intercontinental Medical Statistics data shows some levelling- off of sales in the UK over the past two years. Enthusiastic users believe that the current high prescription cost may well deter potential users.

American pharmaceutical companies estimate that there will be an 80 per cent increase in the use of HRT by the end of the century, as women born in the post-war baby boom years enter the menopause.

Don Barrett, marketing director of the HRT market leader in the UK, Wyeth Laboratories, said that British women tended to take the treatment for a year to 18 months to relieve their menopause symptoms only.

"There is a constant coming in and dropping out - and a lot of patient education has to be done," he said.

"In Britain we tend to think of taking drugs to cure a condition. We are not used, in general, to the idea of taking drugs as preventive medicine. There is some resistance to taking drugs if you are not ill at the time," Mr Barret said.

Pharmaceutical companies are busy developing improved products and delivery methods. Wyeth says it has "three or four" in the pipeline. A competitor, Schering Health Care, aims to launch a patch system of HRT therapy in about six months' time, and is also working on another three products.

Currently there are about 20 HRT preparations on the UK market, including pills, patches, and creams. One of the newest, made by Sanofi, is a three- month system designed so that women only menstruate four times a year.