Help with prescription costs in England

Photo of lots of pillsWorking previously in a pharmacy and advising people on prescription exemptions has been really useful to me as a patient so I’ve written this guide which might help you to lower your health costs

I go through entitlement to free prescriptions, getting help with health costs if you have a low income, and prepayment certificates for those who have to pay. I have also written a blog about abolishing the prescription charge for everyone with long term conditions: Prescription Charges Coalition campaign for free prescriptions

Who is entitled to free prescriptions?

In Scotland, Wales and Northern Ireland there is no longer a charge for prescriptions. In England, whether you pay depends on your age, your income, and your medical condition. The following groups automatically don’t pay:

  • Under-16s and people over 60
  • Those on means-tested benefits such as income-based JSA, income-related ESA, or certain tax credits
  • People with certain medical conditions e.g. diabetes

For a full list of reasons for exemption, see this NHS Choices page

People on contribution-based ESA or contribution-based JSA aren’t automatically entitled because they get these benefits due to having paid enough National Insurance contributions so this isn’t proof of a low income necessarily. Being on DLA or PIP alone doesn’t automatically entitle you to prescriptions because these aren’t means-tested benefits and can be claimed regardless of income, so they aren’t seen as proof of a low income. If you do have a low income, see below.

Important note: If you tick the wrong box or tick a box when you should pay, you are likely to be fined.

If you have a low income

If you have a low income but aren’t covered by any of the exemptions you can apply for the Low Income Scheme. You will either get full help or partial help, depending on your circumstances. This is well worth it as you will get help with prescription, dental and eye care costs and some healthcare travel costs.

To apply for your certificate, you’ll need to complete an HC1 form which you can order online or pick one up at your pharmacy, dentists or opticians and post it. Find out more about the Low Income Scheme

If none of the above applies get a prepayment certificate

If you can’t tick an exemption on the back of a prescription but get regular medication, you might save money by getting a prescription prepayment certificate (PPC). The current prescription charge per item is £8.40. The PPC acts as a cap on prescription charges so that nobody has to pay more than £104 a year for medicines, which works out at £2 a week.

  • A 3-month prepayment certificate costs £29.10 and could save you money if you get 3 or more prescribed items in 3 months.
  • A 12-month certificate costs £104 and saves you money if you will get 12 or more prescription items a year.

You can order a PPC on the NHS Business Services Authority website

Reducing the cost of the PPC is one of the recommendations of the Prescription Charge Coalition, which I’ve written about in Prescription Charges Coalition campaign for free prescriptions

It can be worth asking when you are prescribed something new whether it is available to buy  over-the-counter. If it is it may be cheaper to buy than to pay for a prescription charge but bear in mind that over-the-counter medicines may not be as strong as the prescription-only version, and the pack sizes are often smaller. They must also be for the same indication (health problem or symptoms) as you have been prescribed it for. This might seem like unnecessary red tape but there is only a marketing licence to sell a product for certain indications.

Whilst you’re waiting for a certificate

If you’re waiting for a PPC or low income certificate you will have to pay but ask the pharmacy staff for a NHS receipt. This is an A4 blue form showing how many prescription items which is stamped and signed by the pharmacy. When your certificate arrives you can claim a full refund back from the pharmacy as long as the receipt falls within the date covered by your certificate.

Find out more about getting help with health costs on the NHS Choices website

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