What does the patient pay?

What does the patient pay?

Prescription submission workshop promoNHS prescription charge

The NHS prescription charge for England is currently set at £8.60 per item. 

The Department of Health reviews the prescription charge annually with any changes coming into effect on the 1st April each year.

Exemptions from the English prescription charge 

Part XVI of the Drug Tariff (Notes on Charges) sets out the categories of people who are entitled to exemption or remission from the prescription charge.

Alternatively, for further information please see our page Exemptions from the prescription charge.

You may also wish to visit, or direct patients, to the NHS Help with Health Costs website: www.nhs.uk/healthcosts


Prescriptions from other parts of the UK

Note: only there are only some prescription types which are allowed to be dispensed in England click here for the full list.

When should you collect a prescription charge?

 

English pharmacy

Welsh pharmacy

English prescription

Collect prescription charges according to English rules

Collect prescription charges according to English rules, unless the patient also presents a Welsh prescription charge entitlement card

Welsh prescription Collect prescription charges according to English rules

No prescription charges

Scottish prescription Collect prescription charges according to English rules No prescription charges
Northern Irish prescription

No prescription charges

No prescription charges


How many charges?

Unless the patient claims an exemption, the following rules apply to determine how many prescription charges are payable. 

Scenarios where a single prescription charge applies

Scenario

Example of ONE charge (if written on same prescription)

The same drug or preparation is requested to be supplied in multiple containers. Chloramphenicol 0.5% eye drops 10ml x 2
Different strengths of the same formulation of a drug.

Warfarin 1mg tablets x 28

Warfarin 3mg tablets x 28

Warfarin 5mg tablets x 28

More than one appliance of the same type and specification (other than elastic compression hosiery).

Open-Wove bandages 1 x 2.5cm

Open-Wove bandages 1 x 5cm

Open-Wove bandages 1 x 7.5cm

A set of different components making up a complete appliance. Activa Leg Ulcer Hosiery Kit
Drugs in a powder form prescribed with a separate diluent (e.g. water for injections).

Amoxil 500mg powder for injection x 1

Water for injection 5ml ampoules x 1

A drug which needs to be supplied with a dropper, throat brush or vaginal applicator.

Estriol 0.01% cream

Vaginal applicator type 1

Several flavours of the same preparation.

Ensure Plus Fibre liquid banana

Ensure Plus Fibre liquid strawberry

A medicine which is supplied with an appliance which is not listed in Part IX but is necessary for the drug’s use (see Part XVI, Clause 12.11, Drugs Packed with Non Drug Tariff Appliances).

Emla 5% cream 5g + 2 dressings

(previously known as the “pre-medication pack”)

Scenarios where multiple prescription charges apply

Scenario

Example of TWO charges

Different drugs, types of dressings or appliances prescribed on the same precsription.

Absorbent lint BPC 25g

Absorbent cotton BP 1988 25g

Different formulations or presentations of the same drug.

Prednisolone 1mg tablets

Prednisolone 2.5mg gastro-resistant tablets

Additional components supplied together with a complete set of apparatus or additional dressing(s) together with a dressing pack.

Dressit sterile dressing pack

Crepe bandage 1 x 7.5cm

More than one piece of elastic compression hosiery (anklet, legging, knee cap, below knee, above knee or thigh stocking). 1 pair Thigh Stockings – Class II Black

Additional information on charges

Bulk prescriptions

Part XVI, Clause 9 of the Drug Tariff sets out the arrangements for Bulk prescriptions

No prescription charge is payable when a bulk prescription is dispensed.

For further details on Bulk prescriptions see our page Is this prescription form valid?

Contraceptives

Part XVI, Clause 10 of the Drug Tariff sets out the arrangements for charging of contraceptives.

Prescriptions for the following items are automatically exempt from prescription charges:

  • spermicidal gels, creams, films and aerosols
  • systemic contraceptive preparations listed in Part XVI
  • contraceptive devices listed in Part IXA of the Drug Tariff.

However, there are some products, such as Co-cyprindiol 2000mcg/35mcg tablets, which whilst they do not appear in Part XVI, are sometimes used for contraceptive purposes. In this scenario, if the doctor has endorsed the prescription with “CC”, “OC” or the female symbol (♀) to make it clear that the item is for contraceptive use, the patient should not incur a prescription charge.

Drugs packaged with non-Drug Tariff appliances

Sometimes, such as with Emla 5% cream, a drug is available packaged with items which are appliances that would not normally be allowed on an FP10 prescription because they do not appear in Part IX of the Drug Tariff. These “Non Drug-Tariff Appliances” are only permitted because they are packed with a prescribable drug and are required as part of the drug’s use. Contractors should be aware that the patient would pay just one prescription charge (and the pharmacist would receive only one fee) because the charge is related to the prescribable drug only.

More information is available in Part XVI of the Drug Tariff (Clause 10.11 Drugs Packed with Non Drug Tariff Appliances.)

Elastic hosiery

Multiple charges apply where more than one piece of elastic compression hosiery (anklet, legging, knee cap, below knee, above knee or thigh stocking) are ordered.

Prescription charges for elastic hosiery are calculated per garment (e.g 2 pairs of stockings = 4 garments) but professional fees are calculated per prescription item (e.g 2 pairs of stockings = 1 prescription item). Therefore two pairs of stockings would incur four patient charges and the pharmacy contractor would receive one professional fee.

Lymphoedema garments

Only one prescription charge is payable if the base garments or compression sizes are the same (i.e. both open toe or both class 1). If the size (i.e. S, M, L, XL or I, II, III, IV, V) or length (i.e. standard, petite, short or long – not below knee or thigh high) or colour is different, this would still be one prescription charge regardless of quantity.

Multiple prescription charges for lymphoedema garments apply where completely different base garments (i.e. open toe and closed toe or knee high and thigh high) or the same garment of differing compression sizes (i.e. Class 1, Class 2) are ordered.

Optional extras are classed as no charge items. No additional fees or charges are payable because all that is being dispensed is the base garment with optional modifications.

Multiple dispensing fees (Single Activity Fee)

If on an FP10 prescription there is a request for mixed, assorted or various flavours and the pharmacy contractor endorses to show that several flavours of the same preparation are supplied, they will receive a number of fees equivalent to the number of different flavours supplied. The patient will pay just one charge regardless of how many flavours have been dispensed. If the prescription does not state mixed, assorted or various flavours, only one fee will be paid regardless of whether multiple flavours have been dispensed or endorsed.

The Pricing Authority have also confirmed that when different colours of the same preparation are prescribed on the same prescription form, only one prescription charge should be levied. The pharmacy contractor will receive one dispensing fee for each prescribed colour of the preparation supplied to the patient.


How many charges examples

Click on a question below to reveal the answer.

Q. I have received an FP10 prescription for a Nicorette inhalator starter pack and refill pack, how many prescription charges should the patient pay?

The patient would pay only one prescription charge (and the pharmacist would receive only one fee) as the same drug has been prescribed twice. The inhalator itself is a “non-Drug Tariff appliance” but is allowed because it is packed with the drug (Nicotine inhalator cartridge) and is required to enable the patient to take the medicine. More information is available in Part XVI of the Drug Tariff (Clause 10.11 Drugs Packed with Non Drug Tariff Appliances.)

Q. How many prescription charges should be levied if both carbamazepine 200mg tablets and carbamazepine MR 200mg tablets are prescribed on the same FP10 prescription?

Where different formulations or presentations of the same drug or preparation are prescribed and supplied, multiple prescription charges are payable (see Part XVI, Clause 11.2 of the Drug Tariff). In this example, as standard tablets and modified-release tablets are different formulations, two prescription charges would be payable unless the patient was entitled to exemption or remission from the charge

Q. I have a prescription requesting both Paroxetine 20mg tablets and Seroxat 20mg tablets, how many patient charges do I collect?

One patient charge should be collected  as both items are the same generic drug and the same formulation.

The Pricing Authority does not differentiate between the generic name and brand name as they are both the same generic product.

Q. I have received an FP10 Prescription for two pairs of Thigh Stockings - Class 2. How many prescription charges should the patient pay and how many dispensing fees can I claim?

Prescription charges for elastic hosiery are calculated per garment (2 pairs of stockings = 4 garments) but professional fees are calculated per prescription item (2 pairs of stockings = 1 prescription item), therefore two pairs of stockings would incur four patient charges. The pharmacy contractor would receive one dispensing fee.

Note: -lymphoedema garments are not hosiery, and as such, where more than one lymphoedema garment of the same type is supplied, only one prescription charge should be levied. E.g. Jobst Elvarex Custom Fit Class 1 Thigh High Stockings would incur just one prescription charge.

Q. How many patient charges for two pairs of lymphoedema stockings prescribed on the same prescription but which are different classes and lengths?

As different classes and/or lengths of a lymphoedema garment are recognised as difference types, each type will attract a prescription charge. For example Mediven Elegance Class 1 Below Knee Closed Toe and Mediven Elegance Class 1 Thigh Closed Toe would attract two prescription charges in total.

Q. I have a prescription for Sigvaris Comfort class 1 below knee open toe normal and Sigvaris Comfort class 2 below knee open toe normal lymphoedema garments; how many prescription charges will apply?

Two prescription charges will apply.

Multiple prescription charges for lymphoedema garments apply where completely different base garments (i.e. open toe, closed toe) or the same garment of differing compression sizes (i.e. Class 1, Class 2) are ordered.

Only one prescription charge is payable if the base garments or compression sizes are the same (i.e. both open toe or both class 1). If the size (i.e. S, M, L, XL or I, II, III, IV, V) or length (i.e. standard, petite, short or long – not below knee or thigh high) or colour is different, this would still be one prescription charge regardless of quantity.

Q. If an optional extra is prescribed with a lymphoedema garment on the same prescription, will an extra prescription charge apply?

No, optional extras are classed as no charge items. No additional fees or charges are payable because all that is being dispensed is the base garment with optional modifications. For example: Jobskin MTM Premium class 2 armsleeve lymphoedema garment FP0501-2 = 1 patient charge and 1 dispensing fee. Reimbursement is made for both the base garment and the optional extra at the Drug Tariff list price.

Q. I have received an FP10 prescription for two pairs of Tubifast socks, how many prescription charges apply?

These products are considered to be “stockinettes” rather than “elastic hosiery” and are listed as such in Part IXA of the Drug Tariff. The general rule is that only one charge is payable when more than one appliance of the same type (other than elastic hosiery) is supplied. Therefore, a prescription asking for 2 pairs of Tubifast socks would attract just one prescription charge.

Q. I have a prescription for Emla 5% cream. There is a pack that comes with occlusive dressings, if I dispense this what will I be reimbursed?

To keep in line with the Dictionary of Medicines & Devices (dm+d) descriptions (which prescribers are encourage to do), prescriptions for this item should be written as either:

Emla 5% cream 25g + 12 dressings

OR

Emla 5% cream 5g + 2 dressings

However, if a prescription is written simply as “Emla 5% cream”, pharmacy contractors can still be reimbursed for dispensing any of the available pack sizes (including the dressings packs), as long as they endorse the prescription accordingly (using the descriptions given above).

Please note that the patient would pay just one prescription charge (and the pharmacist would receive only one fee) because the dressings are “Non Drug-Tariff Appliances” which are only permitted because they are packed with a prescribable drug and are required as part of the drug’s use. More information is available in Part XVI of the Drug Tariff (Clause 10.11 Drugs Packed with Non Drug Tariff Appliances.)

Q. How many dispensing fees will I receive for dispensing an FP10 prescription for Qlaira?

Qlaira is a combination product which contains 5 different types of tablet; as such a pharmacy contractor would receive 5 fees for dispensing this item against an NHS prescription. However as Qlaira is recognised as a contraceptive drug, an NHS prescription for this item would not incur a prescription charge.

Q. I have received an FP10MDA prescription for 14 days’ supply with a total of 12 collections of methadone. How many prescription charges would the patient have to pay?

This item would incur just one patient charge. Part XVI, Clause 11.1.1 of the Drug Tariff states that a single prescription charge is payable where “the same drug or preparation is supplied in more than one container” and this is what is being requested on the FP10MDA prescription. More information on instalment dispensing can be found on this page of our website.

Q. A patient has presented one FP10 prescription for Sertraline 50mg tablets and another separate FP10 for Sertraline 100mg tablets. How many charges does the patient pay?

The patient would pay 2 prescription charges. This is because the medicines are on two different prescriptions and therefore each prescription incurs a patient charge.

Further “how many charges” examples can be found in Part XVI, Clause 12 of the Drug Tariff.


FAQs

Q. Do I need to display a notice about the NHS prescription charge?

Yes, it is part of the terms of service to have a notice about the NHS prescription charge. For further information, please see the clinical governance – premises approved particulars provisions.

Q. If a prescription was dispensed before the 1st April but the patient didn't collect it until after the 1st April, should the patient pay the old or the new prescription charge?

There is no national guidance on this issue so pharmacy staff will be required to exercise their professional judgement. Whatever the decision, pharmacy staff are advised to record the charge made and the reasons for doing so on the patient’s PMR record.

Q. I have a prescription for a patient who was 59 when his prescription was written: however, the patient did not handover the prescription to be dispensed until they were 60. Is the patient age exempt from paying a prescription charge?

Yes, subject to the prescription still being within the period of validity. The reverse of a prescription says that entitlement to prescription exemption is based on the patient’s circumstances on the day they are asked to pay.  In this case, as the patient was over 60 when they entered the pharmacy to have their prescription dispensed, they would therefore be age exempt from paying a prescription charge.

Exemption

For paper prescriptions, where the patient’s age is shown on the front of the prescription as “59” they would not be age exempt, unless their 60th birthday has taken place between the time of being provided with the prescription and making their declaration of exemption. The patient should sign the back of the prescription form to declare that they are indeed over the age of 60 on the day they are asked to pay.

For EPS prescriptions, your EPS system may auto-suggest an exemption category but you may need to override this, e.g. systems might use the date the Dispense Notification (DN) was sent and compare this with the patient’s:

  • date of birth; or
  • certificate validity period recorded into the PMR.

However, the date the DN was sent may be different to the date the patient was asked to pay, causing the need to override the exemption category suggested by the system. Please note: The printed patient’s ‘age’ on a prescription token or dispensing token may show the age at the time of the printing.

You can check the paid/exemption category currently applied onto an electronic prescription using your PMR system.

For further information on EPS exemptions, see psnc.org.uk/epsexemption

Q. Do I have to collect a prescription charge for a smoking cessation service commissioned by the local authority, and if so does this not mean that pharmacy would be at a competitive disadvantage compared with other providers who do not collect a prescription charge?

A pharmacy that is providing drugs or appliances as part of a service commissioned by a local authority which is exercising its public health functions under the NHS Act, must make and recover a charge from the patient.  This is the same charge as would be payable when a prescription is dispensed, and the same exemptions apply.  (The charge would apply whichever provider was making the supply, so there is no disadvantage to pharmacies).

Q. A patient has three items on their prescription, but only one item is eligible for his war pension exemption. How can I endorse the prescription to show this?

The Pricing Authority has confirmed that the only way to process these items correctly is to request the prescriber writes two separate prescriptions; one for the item which the patient is going to claim on the war pension exemption certificate and the rest on the other prescription. The contractor will then be able to submit these prescriptions in the relevant exemption group.

Q. Do I have to charge patients 5p when they collect their prescription medicines in a single use plastic carrier bag?

No. A prescription-only medicine bag is an “excluded bag” so pharmacy contractors do not need to charge 5p for a bag intended to be used solely to contain prescription-only medicine, pharmacy medicine or a listed appliance in accordance with a prescription.

Q. A patient has presented a prescription for a generic drug. He/she says that they prefer the brand and are willing pay the pharmacy the difference in cost between the generic and brand. Is this allowed?

No. NHS services are provided free of charge at the point of delivery (unless otherwise prescribed e.g. the NHS prescription charge). However, you may dispense a brand against the prescription for a generic drug provided you do not receive additional payment for dispensing the brand drug, but the choice of which product dispensed would be the pharmacist’s and any additional cost should not be passed on to the patient.

Q. Where patients pay for their prescription, if the product is cheaper to buy, does it say anywhere that you must provide drugs in accordance with the prescription as opposed to supply the drugs privately to the patient?

Yes. It is part of the terms of service that pharmacy contractors must with reasonable promptness “provide drugs so ordered” once a prescription has been presented. Under the NHS Act 2006, there is also a requirement that NHS services are provided free at the point of delivery unless otherwise prescribed (e.g. the NHS prescription charge). Therefore, a patient receiving NHS treatment cannot be charged other than where prescribed. Also, remember that the prescription charge is a payment towards the cost of the NHS and not payment for the actual drugs dispensed – bypassing the prescription will deprive the NHS of the prescription charge.


Guidance documents

PSNC produces the following publications relating to patient prescription charges:

Prescription Charge Card

Whenever there is an increase in the NHS Prescription Charge in England, PSNC produces a pharmacy display card which can be used to inform customers of the rise. It is distributed to all pharmacy contractors in England.

Here is a PDF version of the poster you can print out: 2017 Prescription Charge Card

Multi Charge Card

PSNC publishes a card that lists some of the most commonly dispensed products which incur no prescription charge or multiple prescription charges. It has been designed to be a quick reference guide that can be used on the counter or as a poster.

Multi charge card (2015) 

Prescription Prepayment Certificate Resources

The cost of prescription prepayment certificates (PPC) currently costs £29.10 for a three-month certificate and £104 for a 12-month certificate. PPCs offer savings for those needing four or more items in three months or 13 or more items in one year.

Free resources to promote the Prescription Prepayment Certificate (poster HC20 and leaflet FP95) can be ordered from your local NHS England team. Patients can call the certificate helpline 0300 330 1341 for more information or to obtain a certificate.

Pharmacies will often come across patients who are unable to pay for all their prescription medicines and the Royal Pharmaceutical Society has highlighted a report from the Prescription Charges Coalition, called Paying the Price, which shows that many patients are missing out on medicines they may need because they aren’t aware that they could save money by purchasing a prepayment certificate.


Related resources

REF: Drug Tariff Part XVI

Dispensing Factsheet: Checking Prescription Exemption Status

Exemptions from the prescription charge

Prescription switching

Prescription charge refunds

Is this prescription form valid?

Who can prescribe what?

Controlled Drug prescription forms and validity

Prescription form section of the Pricing Authority’s website (external)

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