Prescription Charges

Background

The United Kingdom is made up of four countries; England, Northern Ireland, Scotland and Wales. Health care across the United Kingdom is universal and free at the point of use however there are charges for some services e.g. prescription medications [3]. In addition approximately 11% of the population have private health insurance [1].

Since 1998 Scotland and Wales have had devolved government [4]. The process of devolution in Northern Ireland’s Assembly is currently still under negotiation, after devolution was suspended in 2002 34. Since devolution, health care has been administered by Scotland and Wales. In England, health care is governed from Westminster [4].

In the UK there is a list of drugs which cannot be prescribed by GPs and a list of drugs that can only be prescribed under certain circumstances however most medications are reimbursable [1]. Medication prescribed by the NHS has attracted a prescription charge since 1952, apart from a brief period between 1965 and 1968 when prescription charging in the UK was abolished [6]. It was however reintroduced in 1968, to save the exchequer money, albeit with extended exemptions, and has continued to apply across the UK since that date, until the recent decision to abolish prescription charges in Wales (see below).

Patient co-payments

In the United Kingdom patients pay a flat rate co-payment for their prescription medication. In England, Northern Ireland and Scotland this is £6.50 [7]. However in Wales, prescription charges are in the process of being abolished. This is being done through a phased reduction of £1.00 per year. The prescription charge in Wales is currently £4.00 [1]. In 2002, co-payments across the UK amounted to 6% of the total NHS drugs bill, the rest being paid for by the government [1].

Reduced Co-Payments

Due to the nature of the UK health system there are no reduced co-payments.

Co-Payment Exemptions

In the UK approximately half the population are eligible for free prescriptions. This amounted to 86% of prescriptions dispensed in 2003 [1]. There is a range of exemptions from prescription medication related co-payments. These include age related exemptions including:

• Patients under 16
• Patients under 19 in full time education, and
• Patients aged 60 or over

Exemption on medical grounds:

• Patients with a valid exemption certificate showing a medical exemption [2]
• Patients with a valid exemption certificate showing that the patient is an expectant mother or has given birth within the last 12 months, and
• Patients with a valid exemption certificate showing evidence of being a war disablement pensioner (exemption applies only for drugs and appliances to treat the accepted disablement).

People with a continuing physical disability with a valid exemption certificate, and
Prescriptions for all contraceptives are available free regardless of a person’s status.

Exemption on the grounds of low income:

• People in receipt of Income Support, or Income-based Jobseeker’s Allowance, or People Credit guarantee credit (also available to partners of this group)
• People entitled to, or named on, a valid NHS tax credit exemption certificate or
  People on the NHS Low Income Scheme [8].

In addition, young people aged under 25 are entitled to free prescriptions in Wales [9].

It should also be noted that hospital based medication is dispensed free of charge.

Cap on Co-Payment

Throughout the UK there is a cap on prescription charges for high use patients. Patients can apply for a prepayment certificate which limits the amount that they pay per year and per quarter for their prescription medication. After purchasing the pre payment certificate, patients do not pay anything further for their prescriptions for the time period the certificate is valid for. In England, Scotland and Northern Ireland, the cost of a prescription prepayment certificate is currently £33.90 for four months and £93.20 for 12 months. However for Wales, as they are in the process of abolishing prescription charges, it is £ 20.93 for a 4 month Pre-Payment Certificate and £57.46 for a 12 month certificate. [9]

Resources

Notes

1. 1. Bronner, M et al (2005) Pharmaceutical Pricing & Reimbursement 2005: a concise guide, PPR Communications Ltd.
   2. betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Concession_cards?OpenDocument [Accessed 9/01/2006] .
   3. sweden.se/templates/cs/BasicFactsheet____6856.aspx [Accessed 13/01/2006]
   4. euro.who.int/document/e68283.pdf [Accessed 13/01/2006]
   5. parliament.uk/commons/lib/research/rp2003/rp03-084.pdf [Accessed 13/01/2006]
   6. nics.gov.uk/index.htm [Accessed 13/01/2006]
   7. rpsgb.org.uk/pdfs/prescriptioncharges.pdf [Accessed 16/01/2006]
   8. dh.gov.uk/PolicyAndGuidance/MedicinesPharmacyAndIndustry/Prescriptions/NHSCosts/fs/en [Accessed 13/01/2006]
   9. wales.nhs.uk/page.cfm?pid=9586 [Accessed 13/01/2006]