England is now the only part of the UK that charges for prescriptions, with charges having been abolished in Wales in 2007, Northern Ireland in 2010 and Scotland in 2011. The cost per prescription is £8.80 due to rise to £9 on 1 April.

How much money does the NHS gain from prescription charges?

For the financial year 2017-18 the NHS received £576 million from prescription charges, according to the Department of Health and Social Care’s annual report.

Who is exempt from prescription charges?

The list of those that are exempt from prescription charges includes people under 16, 16-18 year olds in full-time education, pregnant women, some groups of people on benefits and with low incomes and those over 60. Outside these large groups, there is a list of conditions that are exempt from prescription charges. This list is very short, containing only a handful of conditions, with the exception of the addition of cancer in 2009, it not been updated since 1968. Patients exempt from charges can obtain a Medical Exemption Certificate.

Due to the large group exemptions based on age, the Department of Health estimated in late 2018 that 90% of prescriptions in England are dispensed without charge.

Who is not exempt from prescription charges?

Most working people between the ages of 18 and 60 have to pay for prescriptions. This includes many patients who have chronic conditions that require ongoing medicine to manage their condition and keep them healthy enough to continue working.

The vast majority of chronic conditions are not included on the list of exemptions from prescription charges, including asthma, lupus, rheumatoid arthritis, crohn’s disease, many rare genetic conditions. As a result, most people with a chronic condition who are diagnosed in childhood will be paying for their prescription drugs over their entire working lives. Many more will be paying for many years until they reach 60.


What is a prescription prepayment certificate (PPC)?

This payment option is designed to reduce the cost of prescriptions for people who have chronic conditions and need more than one medicine. The NHS offers two PPC options: a three month PPC, which costs £29.10 and saves money if you need more than three prescribed items in those three months; or a 12 month prescription that costs £104 and will save money if you need more than 12 prescribed items in a year.


What effect do prescription charges have on people with chronic conditions?

The Prescription Charges Coalition report – Still Paying the Price – produced in July 2017 and the survey by Asthma UK published this week, have come to the same conclusions about the effect prescription charges has on people with chronic conditions:

  • Prescription charges are a significant expense for working-age people with long-term conditions, even those working full-time report that they struggle with the cost.
  • If people ration prescriptions due to cost issues, some find themselves in spiralling situation where their health worsens, leading to time off work and even higher medication costs for recovery.
  • If a patient’s condition gets worse due to self-rationing of medication then this results in additional costs to society of emergency treatment, lost productivity, and sick pay.
  • The cost of medication can lead to many patients experiencing significant stress and anxiety due to the fear of not being able to afford their medication. This is then made worse by social isolation due to prioritising medication over the costs of going out.
  • Where people with long-term conditions are managing to afford their medication and avoid rationing, this is often at the cost of other essentials that are important to the management of their condition – such as an adequate diet or heating their home.


Are there campaigns to remove prescription charges for long-term conditions?

Many charities that represent patient groups are calling for a removal of all prescription charges for long-term conditions. An umbrella organisation, the Prescription Charges Coalition, produced the report in June 2017, Still Paying the Price, which found that for many people the cost of prescriptions is a barrier to taking medication.

The Prescription Charges Coalition includes groups such as Asthma UK, Cystic Fibrosis Trust, MS Society, and Parkinson’s UK. A full list can be found here.


What effect did removing prescription charges have in Scotland and Wales?

In wales, a report produced in May 2016 by Statistics for Wales showed that there had been a 40% increase in the number of prescriptions dispensed over the previous ten years; this rise was broadly in line with the gradual rise in prescription dispensation in Wales which had been taking place prior to the abolition of prescription charges in 2007.

In Scotland, where prescription charges were finally abolished in 2011, a report in 2013 indicated that since 2007/08, the number of items dispensed for long term conditions such as asthma, Crohns disease and diabetes, had increased by more than 10,000 items for those with Crohn’s disease and nearly 237,000 items for those with asthma. However, the Scottish government welcomed this increase as evidence that a barrier to medication had been removed and patients were now receiving the correct medication.


So why doesn’t England remove prescription charges altogether like in Wales, Scotland and Northern Ireland.

Removing prescription charges in England will remove revenue of about £500 million from the NHS equivalent to about 0.5% of the annual budget of the Department of Health. The justification for charges mainly rests on this loss of income and that the charge deters ‘frivolous’ or inappropriate consumption of medication.

However, there is some evidence that the removal of prescription charges can actually lead to savings in other areas of the NHS in particular for people with long-term conditions.

In May 2018 a report by the York Health Economics Consortium investigated the economic effect of removing prescription charges for two long-term conditions, Parkinson’s disease and inflammatory bowel disease. For both conditions, the researchers found that for people with these conditions who are not exempt from prescription charges, the economic analysis suggests that any loss in prescription revenue from removing charges would be more than offset by savings to the NHS in England from reduced costs in other areas of healthcare.

For Parkinson’s, it was reduced hospital stays and A&E visits as patients’ were more likely to adhere to medication regimes. For inflammatory bowel disease, the offset would be due to reduced relapse and colorectal cancer rates which would have resulted due to patients not adhering to the correct treatment regimes due to cost reasons.  


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