Eligibility & Prescribing Criteria

1.

Purpose

This policy sets out the eligibility and clinical criteria for prescribing across all SynovaMed services weight loss, hair loss, erectile dysfunction, women's health, skin, sexual health, and any further services added to our formulary. It is written for both patients and clinical staff.

2.

Universal Eligibility Criteria (All Services)

To be considered for a prescription from SynovaMed in any of our clinical areas, you must meet all of the following:

• Aged 18 or over (services for under-18s are not offered)
• A permanent UK resident with a UK delivery address
• Able to provide valid UK photo ID and pass our identity verification
• Able to complete our clinical consultation accurately and honestly
• Have given informed consent to consultation, prescribing, and supply
• Have no contraindication to the medicine being considered

3.

Universal Exclusions (All Services)

We will not prescribe if any of the following apply, regardless of clinical area:

• Patient is under 18
• Patient is not a UK resident
• Identity cannot be verified
• Patient is known or suspected to be obtaining medicine for another person
• Safeguarding concerns are present (coercion, abuse, severe distress)
• Patient has provided materially false information
• Patient has an active eating disorder (where relevant to the medicine)
• Medication would interact dangerously with current prescribed medicines
• The clinical picture needs GP or specialist investigation first

4.

Service-Specific Criteria

Each clinical area has its own specific criteria below. These sit on top of the universal criteria in sections 2 and 3.

4.1 Weight Loss (GLP-1 receptor agonists - Wegovy, Mounjaro)

In addition to the universal criteria:

• BMI ≥ 30 kg/m², or ≥ 27 kg/m² with a weight-related comorbidity (Type 2 diabetes, hypertension, dyslipidaemia, obstructive sleep apnoea, cardiovascular disease)
• No history of acute or chronic pancreatitis
• No personal or family history of medullary thyroid carcinoma or MEN 2
• Not pregnant, breastfeeding, or planning pregnancy within 2 months
• No severe renal impairment (eGFR <15) or severe hepatic impairment
• No active or recent (within 5 years) eating disorder without specialist discharge
• Not on insulin or sulfonylurea without clinical review (hypoglycaemia risk)

4.2 Hair Loss (finasteride, minoxidil)

In addition to the universal criteria:

• Confirmed androgenetic alopecia (male or female pattern hair loss)
• Finasteride: adult male patients only; not to be handled by pregnant women due to teratogenic risk
• Finasteride contraindicated in: history of breast cancer, liver impairment, hypersensitivity to the drug, known mental health concerns (post-finasteride syndrome risk discussed at consent)
• Minoxidil (oral or topical): no uncontrolled hypertension, no severe cardiovascular disease, not pregnant/breastfeeding (topical acceptable with care)
• Photograph evidence of hair loss pattern may be requested

4.3 Erectile Dysfunction (PDE5 inhibitors sildenafil, tadalafil, etc.)

In addition to the universal criteria:

• No use of nitrates (including GTN spray, isosorbide)
• No use of guanylate cyclase stimulators (e.g. riociguat) absolute contraindication
• No severe cardiovascular disease (recent MI, unstable angina, severe heart failure)
• Blood pressure within acceptable range (below 170/100 mmHg)
• No severe hepatic impairment
• No known retinitis pigmentosa or non-arteritic anterior ischaemic optic neuropathy (NAION)
• Underlying cause considered unexplained ED in a younger patient may warrant GP review for cardiovascular or endocrine cause

4.4 Women's Health - Contraception

In addition to the universal criteria:

• Combined hormonal contraception: no history of VTE, no migraine with aura, no smoking age > 35, BMI < 35, no uncontrolled hypertension, no breast cancer history
• Progestogen-only pill: suitable for broader group; breast cancer history remains a contraindication
• Emergency contraception: based on timing of unprotected intercourse and clinical suitability of levonorgestrel vs ulipristal acetate
• Safeguarding questions included in every women's health consultation

4.5 Women's Health HRT / Menopause

• Confirmed perimenopausal or menopausal symptoms
• No oestrogen-sensitive cancer (breast, endometrial)
• No recent VTE or active thromboembolic disease
• No undiagnosed vaginal bleeding
• No uncontrolled hypertension or severe liver disease
• Annual review required

4.6 Women's Health Acute (UTI, BV, Thrush)

• Symptoms consistent with the condition
• No red flags (fever, loin pain, haematuria, pregnancy complications) that warrant GP/A&E;
• Not recurrent recurrent presentations signposted to GP
• Pregnancy status confirmed before antibiotic/antifungal choice

4.7 Skin (prescription skincare - tretinoin, topical antibiotics, acne)

• Condition suitable for topical prescription treatment
• Not pregnant or breastfeeding (tretinoin and oral isotretinoin contraindicated)
• No severe cystic acne requiring specialist referral
• No history of retinoid hypersensitivity
• Patient understands photosensitivity and sun-protection requirements

4.8 Sexual Health (STI treatment)

• Diagnosed or reasonably-suspected condition based on symptoms or positive test
• Partner notification discussed
• Not a condition requiring parenteral treatment (e.g. syphilis, gonorrhoea - signposted to GUM clinic)
• No penicillin allergy if penicillin-based treatment planned
• Patient understands importance of completing course and retesting where indicated

5.

Clinical Investigations We May Request

Before prescribing or during treatment, our prescribers may ask you to provide evidence, including but not limited to:

• Recent blood test results (HbA1c, U&E, LFT, lipid panel, hormone profile, as relevant)
• Blood pressure reading
• A photograph relevant to the clinical question (e.g. hair loss pattern, skin lesion, weight verification)
• A summary of your GP medical records
• A short video consultation for safety or identity verification
• Pregnancy test result (where pregnancy status affects prescribing)
• Recent STI test results (for sexual health consultations)

6.

Safeguarding Screening

Every consultation - regardless of clinical area includes screening questions designed to detect:

• Coercion or pressure from a third party
• Active mental health distress or suicidal ideation
• Intent to supply the medication to another person
• Signs of domestic abuse or exploitation
• Service-specific safeguarding flags (e.g. eating disorder for weight loss, body dysmorphia for skincare, coercive control for contraception)

Positive screens trigger decline and signposting to the appropriate service (GP, BEAT, Samaritans, Refuge, NHS 111, or safeguarding authority as appropriate).

7.

Evidence Standards

We rely primarily on patient self-report, supplemented by verification steps where the clinical context requires them. Where red flags or inconsistencies are present, we request corroborating evidence (GP records, photographs, or blood tests). Providing false information to obtain medication is a criminal offence and we reserve the right to report serious cases to the authorities.

8.

Policy Review

Reviewed every 2 years, or sooner if guidance or evidence changes. Next review: April 2028.

SynovaMed (trading name of Nihaal Limited) | 11 Blaby Road, South Wigston, Wigston, LE18 4PA | GPhC: 9012552 | 07822 002914 | info@synovamed.co.uk Document Ref: POL-007 | Version 2.0 Effective: 19 April 2026 | Next Review: April 2028 Superintendent Pharmacist: Chirag Desai (GPhC: 2079415)