Prescription charges

Prescription charges, in the English NHS are charges made for prescription medications. The majority of adults are required to pay them. Charges were abolished in NHS Wales in 2007, Health and Social Care in Northern Ireland in 2010 and by NHS Scotland in 2011. In 2010/11, in England, £450m was raised through these charges, some 0.5% of the total NHS budget. In 2020 the charge is £9.15 per item.

History

When the National Health Service was established in 1948 all prescriptions were free. The power to make a charge was introduced in the NHS Amendment Act 1949, and proposals for charges were a factor in the resignation of Aneurin Bevan from the Labour Government in 1951. Charges were introduced in 1952, by the Conservative government, at a rate of one shilling per prescription.

There were exemptions for people in receipt of National Assistance or War Disability Pension, children under 16 or at school, and venereal disease patients. In 1956 the rules were changed so that a charge applied to each item prescribed. In 1961 it was doubled to 2s. Charges were abolished by the Wilson Government on 1 February 1965, but reintroduced on 10 June 1968 at the higher rate of 2s 6d, but with a wider range of exemptions. As of 2020, in England, the prescription charge is £9.15.

Prescription charges and exemptions are administered by the NHS Business Services Authority.

The existing list of medical exemptions is essentially a list of conditions for which long-term life-saving medication was available in 1968, and it has never been revised since. The policy on prescription charges was dismissed as a "dog's dinner" by the Social Market Foundation, who said in 2003 that the current rules on who pays for medicines and who does not are unfair and illogical.

In 2007, a survey conducted by Ipsos Mori found that 800,000 people failed to collect a prescription during 2007 due to cost.

In 2008, 88% of patients in England got medicines free. Gordon Brown introduced an exemption for cancer patients in 2009, and promised free prescriptions for people with long-term conditions.

Jeremy Hunt announced a scheme to help reduce waste and encourage patients to complete courses of medicine in July 2015. Any drug that costs the NHS more than £20 was to be marked with a label stating that they have been "funded by the UK taxpayer", along with the total price that the prescription costs the health service. It had not been implemented by April 2017.

The Prescription Charges Coalition, a campaigning organisation of which the Royal Pharmaceutical Society and numerous organisations of disabled people are members, launched a survey investigating the impact of prescription charges on people in England with long-term conditions in March 2017. It advocates free prescriptions for everyone with long-term conditions. In July 2017 they said a third of patients of working age have not collected a prescription because of cost.

The Royal College of General Practitioners launched a campaign in May 2017 to scrap mental health prescription charges for students.

Exemptions

Prescriptions in England are free for:

• children under 16,
• people 16–18 and in full-time education,
• people who get some means-tested benefits such as Income Support, income-based Jobseeker's Allowance, income-related Employment and Support Allowance or the guaranteed credit part of Pension Credit and Universal Credit if their net earnings are £435 or less in the last month, or £935 or less if they get money for a child or who have a limited capability to work,
• people over 60,
• women who are pregnant or have had a baby in the previous 12 months and have a valid maternity exemption certificate (MatEx)
• people who have a certificate (HC2) entitling them to help under the NHS Low Income Scheme. An HC3 certificate gives some help but not exemption from charges.

In February 2019 the prescription exemption forms had not been updated to include Universal Credit and patients were advised to tick the box for Income based Jobseeker's Allowance. Universal Credit was finally included in January 2020, seven years after its first introduction.

Medical exemptions

Patients with any of these conditions who have a valid medical exemption certificate (MedEx) are entitled to free prescriptions, for all conditions, not merely the qualifying condition:

• epilepsy needing continuous therapy
• a permanent fistula
• diabetes mellitus
• Hyperthyroidism (Graves' disease)
• myxoedema which occurs in hypothyroidism, or hyperthyroidism
• hypoparathyroidism
• diabetes insipidus or hypopituitarism
• Addison's disease and other forms of hypoadrenalism
• myasthenia gravis
• any continuing physical disability which stops them going out alone
• undergoing treatment for cancer, including the effects of cancer, or the effects of current or previous cancer treatment

Medical Exemption Certificates last for five years or until the 60th birthday, whichever is sooner. A Certificate does not provide help with the cost of NHS wigs or fabric supports.

Medicines administered at an NHS hospital or an NHS walk-in centre, personally administered by a GP, contraceptives or supplied at a hospital or clinic for the treatment of a sexually transmitted infection or tuberculosis are always free.

War pensioners do not pay if the prescription is for their war disability.

There is concern that exemptions are arbitrary and many chronic illnesses are not included in the list which exempt patients from charges. Some people on low income cannot easily afford their prescriptions. Some people do without prescriptions they need when they are short of money and end up in hospital. Arguably this costs more than providing free prescriptions would.

Administration

A new online tool to help patients understand the eligibility criteria for free prescriptions was launched in September 2018. Matt Hancock announced in October 2018 that prescription exemptions are to be digitised so that pharmacies can check whether the patient is exempt from charging before their medication is dispensed. Pharmacies or other dispensing contractors are reimbursed for the cost of the medicines through NHS Prescription Services, a division of the NHS Business Services Authority. An online eligibility checking system is to be piloted in the Positive Solutions Analyst pharmacy IT system that supplies to “about 10% of pharmacies” during 2019.

Penalties

A person who claims exemption without having a valid exemption certificate is liable for a penalty charge, which is five times what they should have paid, up to a maximum of £100, plus the original charge itself. If they do not prove entitlement to help with health costs, and do not pay the amount stated in the penalty charge notice, the NHS may take court action to recover the debt. The penalty charge is increased by 50 percent of the penalty charge if they do not pay within 28 days of the date the penalty charge notice is sent. 979,210 people were fined in 2016–17, double the number, 494,129, in 2015–16. Most had failed to renew their certificate, as there was no effective reminder system. The Public Accounts Committee found in 2019 that 1.7 million incorrect penalties had been overturned since 2014, almost a third of the fines issued – worth £188 million. The committee commented on the “breathtaking complacency” of the fining system. 21,497 penalty notices were withdrawn in 2018/2019 because the patient had actually paid.

Discounts

For those who do not qualify for free prescriptions, Prescription Prepayment Certificates (PPC) are available. They are worthwhile if more than 12 prescriptions are needed in a year. They can be paid for by 10 monthly direct debit instalment payments. There are also three-month PPCs which are worthwhile if the patient needs more than 3 prescriptions in 3 months. A partial refund is available for patients who become exempt from prescription charges, the amount depending on the length of the PPC and when and how the patient's circumstances change.

Some medicines do not cost as much as a prescription charge, and can be bought from the same pharmacist.

There are also prescription discount programs available that prescribers can apply to such as RxSaver and GoodRx.

Refunds

Refunds are available "Where any person who is entitled to a repayment of any charge paid under the Charges Regulations presents an NHS pharmacist with a valid claim for the repayment within three months of the date on which the charge was paid, the NHS pharmacist must make the repayment." (Regulation 96 of the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013).

If a patient is unsure if they are entitled to free prescriptions, to avoid a fine they should pay for their prescription and request an FP57 Refund and Receipt Form. A refund can then be claimed within three months if they are in fact exempt.

Refunds do not have to be made by the pharmacy, hospital or other NHS organisation that issued the FP57 that can be obtained through any NHS England pharmacy on presentation of a valid FP57 along with proof of exemption.

Blacklist

If the prescriber has the appropriate prescribing rights, any food, drug, toiletry or cosmetic may be prescribed on an NHS prescription unless it is listed in the blacklist – Schedule 1 to the NHS (General Medical Services Contracts) (Prescription of Drugs etc.) Regulations 2004, reproduced in Part XVIIIA of the Drug Tariff.

Ireland

The Drugs Payment Scheme ensures that a family ordinarily resident in Ireland has to pay no more than €124 per calendar month for a month's supply of prescribed medicines and medical appliances. Family means a person or a couple and their children aged under 18 (or under 23 if in full-time education) and any family member who has a physical or intellectual disability or an illness and is unable to fully maintain himself/herself.

Those who are entitled to a medical card pay a government levy for each item dispensed. The levy is €2.00 up to a maximum of €20 per family per calendar month. The levy was reduced to €1.50 from April 2019 for medical card holders over the age of 70.

The Over 70s prescription charge is to be reduced to €1, and the Drugs Payment Scheme cap reduced to €114, from 2020

The Long Term Illness Scheme provides free drugs, medicines and medical and surgical appliances for the treatment of specified conditions:

• Intellectual disability
• Mental illness (for people under 16 only)
• Diabetes insipidus
• Diabetes mellitus
• Haemophilia
• Cerebral palsy
• Phenylketonuria
• Epilepsy
• Cystic fibrosis
• Multiple sclerosis
• Spina bifida
• Muscular dystrophies
• Hydrocephalus
• Parkinsonism
• Acute leukaemia
• Conditions arising from use of Thalidomide

See also

• Prescription drug
• Prescription costs – for the situation in other countries

External links

• Help with health costs at NHS Choices
• Help with Health Costs at NHS Business Services Authority