In a significant move towards enhancing women’s health, the HRT Arrangement launched on 1 June 2025. This initiative provides free menopause medication to women at participating pharmacies, ensuring that this medication and dispensing fees are covered, making the treatment accessible to all eligible women. In this article Ciaran Mulligan, Interim Contracts Manager, outlines how the HRT Arrangement operates.
The Health Insurance (Amendment) and Health (Provision of Menopause Products) Act 2024, together with a subsequent commencement order and secondary legislation, provides for the supply of medication for the treatment of menopause free of charge to women ordinarily resident in the State. PCRS Circular 008/25 outlines how these medications can be reimbursed under the HRT Arrangement.
The HRT Arrangement is designed to support women at various stages of menopause, including perimenopause, post-menopause, early menopause, premature menopause, and medically induced menopause. Legislation does not specify an age cohort, making it inclusive for all women experiencing menopause-related symptoms.
It includes a €5.00 dispensing fee per item (which does not form part of the tiered fee structure) and a €2,000 implementation grant for pharmacies that signed up to provide the service by 1 June 2025.
Figure 1: IPU resources available for HRT Arrangement
The arrangement applies to women who hold either General Medical Services (GMS) or Drugs Payment Scheme (DPS) eligibility. Private patients and GMS patients who will be accessing Exempt Medicinal Product (EMP) HRT without an GMS administrative code will need to register for DPS eligibility. They are encouraged to apply for this in advance, but pharmacies can submit an emergency DPS application on the patient’s behalf if there is an immediate need.
The PCRS published Circular 008/25, which outlined the operation of the HRT Arrangement and included a list of HRT medications covered under the Arrangement. Since then, the PCRS has confirmed additional medications which are available under the HRT Arrangement. However, there are currently no plans to issue a new circular.
To support you, we have published a full list of medications available under the HRT Arrangement section of our website. We will continue to update this as we receive more information from the PCRS. Additional medications may be reimbursable under the Arrangement on an individual basis. If you are uncertain if a product is eligible under the Arrangement, please contact the PCRS Pharmacy Function at pharmacy.response@hse.ie to confirm.
A list of the medications which the PCRS has confirmed will not be reimbursed under the HRT Arrangement is also available on our website.
In cases where there is a shortage of a particular strength, pharmacies will be reimbursed for dispensing multiples of a lower strength (for example, during a shortage of Estradot 100mcg/24hr patch you are allowed to claim for two x 50mcg/24hr patches instead).
Where there is a shortage of a medication on the Reimbursement List, reimbursement is supported for the EMP where there is no suitable therapeutic alternative.
The arrangement also supports the reimbursement of off-label use of certain HRT medications (for example, Testogel), with temporary administrative codes issued for these products.
All prescriptions meeting legal requirements are acceptable, and there is no need for prescribers to indicate menopause as the treatment reason.
For GMS patients presenting with private prescriptions, these will need to be transcribed by their GP onto a GMS prescription to be reimbursed under the HRT Arrangement. However, hospital prescriptions for GMS patients for HRT products can be claimed under the Hospital Emergency Scheme as per the usual arrangements.
If a private patient does not have DPS eligibility, then they must register for the DPS to avail of the HRT Arrangement:
HRT medications are zero rated for VAT so the only medications which should have 23 per cent VAT are those which are not indicated or mainly used for the treatment of menopause, for example Testogel.
As with all 777 coded items, the PCRS should be contacted to confirm that the medication and its price will be covered under the Arrangement.
Claims submission is likely to mirror your existing practices as the HRT Arrangement medications are dispensed under either GMS or DPS, but if you have any queries about the claiming process you should contact your vendor for assistance.
HRT Arrangement claims will be reported under their usual scheme pathway, so if dispensed under GMS, they will appear in the GMS Itemised Claims Listing report and if dispensed under DPS, they will appear in the DPS report.
The €2,000 implementation grant will be paid in June 2025 and reported under adjustments in the Itemised Claims Listing.
To facilitate the implementation of the HRT Arrangement, various resources are available on the HRT Arrangement section of our website. These include:
“The HRT Arrangement is designed to support women at various stages of menopause, including perimenopause, post-menopause, early menopause, premature menopause, and medically induced menopause.”
The HRT Arrangement represents a significant step forward in making essential healthcare accessible to women experiencing menopause. By providing free HRT medications and covering dispensing fees, the initiative aims to provide equitable access for all women.
For more information, visit the HRT Arrangement webpage or contact the Contract Department at contract@ipu.ie.
Ciaran Mulligan MPSI
Interim Contracts Manager, IPU
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