In response to a significant ongoing disruption to the supply of Estraderm MX® 25mcg and 100mcg patches, two new Serious Shortage Protocols (SSPs) have been issued by the Department of Health and Social Care (DHSC).

Effective today, 8 September 2022, SSP035 and SSP036 provides that for every Estraderm MX® 25mcg or 100mcg patch originally prescribed, one Evorel® 25mcg patch or 100mcg patch must be supplied, respectively.

Both SSPs are currently set to expire on 16 September 2022.

The SSPs may be amended or revoked at any time  – PSNC will update contractors on any changes.

SSP035 for Estraderm MX® 25mcg patches

For prescriptions (NHS or private) requesting:
Supply permitted under SSP035:
Estraderm MX® 25mcg patches
Evorel® 25mcg patches

SSP036 for Estraderm MX® 100mcg patches

For prescriptions (NHS or private) requesting:
Supply permitted under SSP036:
Estraderm MX® 100mcg patches
Evorel® 100mcg patches

Both SSPs, authorised by the Secretary of State, have been developed by clinicians and provides pharmacists with procedures to follow in providing either of these suitable alternative products to help reduce the number of patients having to return to their prescriber for a replacement prescription.

Key points relating to SSP035 and SSP036

These protocols do not allow for the quantity supplied to be less than the number of days prescribed on original prescription.
There are no SSPs in place for Estraderm MX® 50mcg patches and 75mcg patches – these strengths are not affected by supply disruptions and should continue to be dispensed in accordance with the prescriptions
The SSP035 and SSP036 only allow substitution of Estraderm MX®25 or 100 patches with Evorel® 25 or 100 patches, respectively.
The SSPs do not allow pharmacists to double up strengths for example, pharmacists cannot supply 2 x Estraderm MX®50 patches against a prescription ordering 1 x Estraderm MX®100 patches.
Ensure that patients considered unsuitable for inclusion are promptly referred to their prescriber for further advice.
The supervising pharmacist should ensure that the patient’s prescriber is notified when supplying a patient in accordance with these SSPs
The supervising pharmacist, using their professional judgement determines that swapping the patient to a different brand of a patch would not be suitable for the patient
For endorsing requirements please refer to NHSBSA’s supporting guidance for SSP035 and SSP036 respectively.

Pharmacists must exercise their professional judgement to ensure the alternative products are suitable for the patient.

Contractors will receive an email to their shared NHSmail account informing them of these SSPs and pharmacy teams are advised to read the documentation for SSP035 and SSP036 in full and to implement the protocol with immediate effect. Pharmacists are required to read and comply with the requirements outlined within the individual SSP as published on the NHSBSA website for SSP035: Estraderm MX® 25mcg patches and SSP036: Estraderm MX® 100mcg patches


Reimbursement is for the medicine supplied in accordance with the SSP and not the originally prescribed medicine i.e. in this instance contractors will be reimbursed the reimbursement price for either Evorel® 25mcg patches or 100mcg patches. The reimbursement price will account for VAT payment. Supply in accordance with the SSP will result in the following fees being paid to the contractor:

One Single Activity fee (currently £1.27)
One SSP fee (£5.35)

Support in implementing the SSPs

The following resources have been developed to support pharmacy teams in using these protocols.

Current versions of SSPs

Serious Shortage Protocols Operational Guidance

Serious Shortage Protocols Questions & Answers

PSNC’s Serious Shortage Protocols (SSPs) Endorsing Factsheet

PSNC Briefing 023/19: Serious Shortage Protocols – A guide for community pharmacy teams

Background information on SSPs

Further information on what SSPs are and when they may be used is available via the links below.

Serious Shortage Protocols (SSPs) on-demand webinar

Serious Shortage Protocols (SSPs) webpage

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