In the English NHS charges are made for prescription drugs, and the majority of adults (though not a majority of patients) 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 prescription charges, some 0.5% of the total NHS budget.
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 2018, in England, the prescription charge is £8.80.
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.
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.
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 Universal Credit,
- 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.
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
- 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.
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.
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.
Other ways of paying less than the full prescription charge
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.
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.
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.
- Department of Health Resource Accounts 2010/11
- Bevan, Aneurin. "Bevan's Resignation speech 23 April 1951". Socialist Health Association. Retrieved 27 December 2013.
- "B.M.A. worried by charges. Concern at Medical Consequences". The Glasgow Herald. 26 October 1956. p. 10. Retrieved 23 November 2016.
- "Prescription Charges". Socialist Health Association. Retrieved 27 December 2013.
- "NHS Prescription Costs". NHS England. Retrieved 12 April 2016.
- "Prescriptions policy is 'dog's dinner'". BBC News. 15 June 2003. Retrieved 27 December 2013.
- "After the concessions – carry on campaigning for the abolition of prescriptioncharges in all of the UK". Abolish Prescription Charges. Retrieved 27 December 2013.
- "Protestors call on Gordon Brown to abolish prescription charges". PR Week. 1 February 2010. Retrieved 27 December 2013.
- "Patients to be told price of prescribed drugs in bid to save NHS £300m". Independent. 1 July 2015. Retrieved 1 July 2015.
- "Prescription Charges Coalition launches survey into long-term conditions". Pharmaceutical Journal. 20 March 2017. Retrieved 29 March 2017.
- "Working people struggle to afford multiple prescriptions". Pharmaceutical Journal. 5 July 2017. Retrieved 23 August 2017.
- "Student mental health costs should be free, according to the Royal College of GPs". BBC Newsbeat. 4 May 2017. Retrieved 6 May 2017.
- "Should the long-term ill have free prescriptions?". BBC News. 29 June 2017. Retrieved 23 August 2017.
- "Check before you tick". NHS Business Services Authority. Retrieved 11 October 2018.
- "NATIONAL CAMPAIGN TO GENERATE AWARENESS OF FREE PRESCRIPTION CRITERIA LAUNCHED". Pharmacy Biz. 10 September 2018. Retrieved 11 October 2018.
- "Free prescriptions face huge crackdown as Tories bid to cut NHS bill by £300million a year". Mirror. 14 October 2018. Retrieved 14 October 2018.
- "Prescription fines doubled in last year: RPS says 'more constructive approach' needed". Pharmaceutical Journal. 7 July 2017. Retrieved 23 August 2017.
- "Prescription prepayment certificates(PPCs)". NHSBSA. Retrieved 18 January 2016.
- "Claiming refunds of prescription prepayment certificates (PPCs)". NHSBSA. Retrieved 18 January 2016.
- "The NHS in England: About health costs: Prescription costs". NHS Choices. Retrieved 28 February 2016.