Exemptions from the prescription charge

Exemptions from the prescription charge

 

QUICK LINKS

REF: Drug Tariff Part XVI
EPS exemption
Switching
Prescription Charge Refunds

As part of a pharmacy’s Terms of Service, pharmacy staff must ask any person who makes a declaration that the patient is exempt from paying a prescription charge to produce satisfactory evidence of such entitlement. The legislative requirement is set out in paragraph 7 of the Terms of Service, which is available to view here.

Where appropriate, pharmacy staff should advise patients of the required certificates and how they might go about obtaining them (e.g. Medical Exemption Certificates required for patients suffering from diabetes, epilepsy etc. as well as exemption certificates on maternity grounds, low income, or Prescription Prepayment Certificates (PPC)).

If a patient is unsure whether they are entitled to free prescriptions, pharmacy staff should advise the patient to pay for their prescription and provide them with an  FP57 Refund form with information on how to claim a refund at a later date. Further information for patients can be found at www.nhs.uk/healthcosts.

If a valid certificate of exemption has been shown, for example a medical exemption certificate or pre-payment certificate, and noted on the PMR along with the certificate’s expiry date, it is not necessary to ask the patient to show proof again within the validity of that certificate. Patients claiming exemption because they receive Income Support or Jobseeker’s Allowance (income-based) should be asked to provide their evidence of entitlement on each occasion.

Where patients do not have evidence or where there is doubt over whether the evidence provided is appropriate, the “Evidence not Seen” box on the back of the prescription should be marked with an X by pharmacy staff. Pharmacy staff need not refuse to dispense items on the basis that the patient does not provide evidence of their entitlement to free prescriptions.

NHS fraud checking notification

On 1 July 2016, pharmacy contractors will be required by their Terms of Service, before supplying the drug or appliance, to advise the person claiming exemption from payment of NHS prescription charges – where evidence is required but not provided – that NHS checks are routinely undertaken to verify that such persons are exempt from payment of NHS prescription charges, as part of arrangements for preventing or detecting fraud or error. It is up to pharmacy teams how this is done but it must be in “appropriate terms”. The PSNC Briefing 032/16: NHS fraud checking notification (June 2016) includes our tips of key things to consider to make compliance with this new requirement a matter of routine.

Patient requirements

Pharmacy contractors are in no way responsible for the accuracy of a patient’s declaration; this remains the responsibility of the patient. NHS Protect have a responsibility to check for prescription charge exemption fraud and patients found to have wrongly claimed for free prescriptions, could face a penalty charge and in some cases prosecution.  This applies even where the patient has a medical condition which qualifies for exemption, if the patient does not have a valid exemption certificate on the date the patient is asked to pay or complete the exemption declaration.


Exemption categories and proof required

Exemption category

Who is exempt?

Proof required

How to obtain the required proof

Age exempt Children under 16 years of age and men and women aged 60 years and over are entitled to exemption.  If the patient is exempt for this reason and their date of birth is computer generated on the prescription or included in the electronic prescription message, the patient is not required to complete the exemption declaration and no evidence is required. If the date of birth is hand-written or not computer printed on the prescription, the patient must complete the exemption declaration. Evidence that could be shown includes a passport, birth certificate, or any other official papers showing the patient’s name and date of birth. For children under 16, if the child is obviously under 16, no evidence is required.  N/A
Full-time Students aged 16, 17 or 18 Must be aged 16, 17 or 18 and in full-time education. Full-time education means you must be receiving full-time instruction from a recognised educational establishment, such as a school, college or university; therefore apprenticeships are not eligible. (However patients may qualify for a HC2 certificate under the NHS Low Income Scheme) Evidence that should be shown is proof of the patient’s date of birth (see above) and proof that the patient is a full-time student (e.g. Student Card or letter from school/college). Proof can be obtained from the patient’s school, college, university or local education authority (LEA).
Patients who have a valid Maternity Exemption Certificate Pregnant women and those who have had a baby in the last 12 months get free prescriptions if they have a valid Maternity Exemption Certificate. A patient in receipt of a Maternity Exemption Certificate who has a miscarriage, abortion/termination of pregnancy or stillborn birth is entitled to use their Maternity Exemption Certificate for NHS Prescriptions until the certificate expires. Patients are required to complete a FW8 form available from GPs, Midwives and health visitors. The GP, Midwife or Health professional is required to sign the form and send it off to the Pricing Authority who will issue the certificate. More information is available on their website.
Patients who have a valid Medical Exemption Certificate  To claim exemption under this category, it is necessary for the patient to have a valid medical exemption certificate, not simply a medical condition. The list of conditions which would entitle a patient to a medical exemption certificate can be found in Part XVI of the Drug Tariff. Medical exemption certificates are typically, although not uniformly valid for 5 years.  Note: a medical exemption certificate is always required – the fact that a patient has one of the qualifying conditions is not sufficient to claim entitlement to exemption from the charge. Patients are required to complete a FP92A form which is available from GP surgeries. The GP is required to sign the form and send it off to the Pricing Authority who will issue the certificate. More information is available on their website.
Patients who have a valid Prescription Pre-payment Certificate (PPC)  Anyone can purchase a PPC. Appropriate evidence of exemption would be the certificate itself. Note: Patients may backdate their PPC up to one month from the date that they apply. If the patient intends to buy a PPC, they should be asked to pay for their prescription, provided with the FP57 Receipt and advised on how to obtain a refund. (Pharmacies can obtain copies of Form FP95 PPC application leaflet from their local NHS England team). The cost of prescription prepayment certificates is currently £29.10 for 3 months or £104.00 for 12 months.

Patients can obtain a prescription pre-payment certificate by completing a FP95 form which is available from pharmacies and doctors surgeries. Pharmacies can obtain copies of the FP95 form from their local NHS England team.

Alternatively, patients can order a PPC over the telephone with a credit or debit card (0300 0330 1341) or from the NHSBSA website.

The Pricing Authority is responsible for issuing Prescription Pre-payment Certificates. More information is available on their website.

The patient is named on a current HC2 Charges Certificate Anyone on a low income can apply to get this certificate. Appropriate evidence of exemption would be the certificate itself. Patients who are not entitled to help with health costs under any other category may apply for help under the NHS Low Income Scheme. 

Patients may claim for help with health costs under the NHS Low Income Scheme using the HC1 form, obtainable from Jobcentre Plus Office or by calling 0300 330 1343. HC1 forms may also be available from the local hospital, dentist, optician or GP surgery. Pharmacies can obtain copies of Form HC1 by calling 3M Supplies on 0300 123 0849 Option 1.

The Pricing Authority administer the NHS Low Income Scheme, more information is available on their website.

The patient or his/her Partner is entitled to, or named on, a valid NHS Tax Credit (TC) Exemption Certificate  Not all patients receiving tax credits are entitled to free prescriptions – those patients that are entitled are automatically sent an ‘NHS Tax Credit Exemption Certificate‘ by the Pricing Authority. Appropriate proof of exemption would be the NHS Tax Credit Exemption Certificate. Exemption certificates are sent automatically to eligible patients. Patients who are unsure as to whether they are entitled to help with health costs via tax credits, can contact HM Revenue and Customs for support: 0345 300 3900.
The Patient or his/her Partner is receiving Income Support (IS)  Exemption certificates are
sent automatically to eligible
patients.
Note some letters and documents issued by the DWP about income support, while relating to the patient (or their partner) do not show dates of entitlement therefore these are not acceptable evidence. An entitlement letter from the Jobcentre Plus Office would be appropriate evidence of exemption. Patients can speak to their Jobcentre Plus Office.
People Receiving Income-based Jobseeker’s Allowance  Note there are two types of Jobseeker’s Allowance (JSA), income based and contribution based. Only receipt of income based JSA entitles patients to free prescriptions. JSA is paid by giro cheque or BACS two weeks in arrears so patients may not have evidence. A letter from the DSS/patient’s local Job Centre Plus Office that states their entitlement would be appropriate evidence. The letter must confirm that the patient was entitled to free prescriptions on the date the patient completed the exemption declaration. Patients can speak to their Jobcentre Plus Office.
Universal Credit (UC) As part of the government’s changes to the benefit system, UC is a new benefit introduced from April 2013. Those receiving this benefit will be eligible for free prescriptions.  A valid UC award letter bearing their name
(either as the recipient or because they are
a partner or child of the recipient) is
appropriate proof; they should sign to
declare their exemption and will need to
tick the box for “income based
Jobseeker’s Allowance”.
Please see our page on Universal Credit update or further information can be found here
The Patient or his/her Partner is getting Pension Credit Guarantee Credit (PCGC) Those in receipt of PCGC. A letter from the DSS/patient’s local Job Centre Plus Office would be appropriate proof. The letter must confirm that the patient was entitled to free prescriptions on the date the patient completed the exemption declaration. Patients can speak to their Jobcentre Plus Office.
The Patient is a War Pensioner holding a War Pension Exemption Certificate and the Prescription is for the Accepted Disablement Those holding a War Pension Exemption Certificate. Appropriate proof of exemption would be a war pension exemption certificate. Patients can apply for a war pension exemption certificate by writing to The Veterans Agency, Norcross, Blackpool FY5 3WP. or telephoning 0800 169 2277.
Employment and Support Allowance (ESA) Only patients receiving the income related strand of ESA will be entitled to free prescriptions. The patient should be able to provide evidence in the form of a DWP award notice. Patients can speak to their Jobcentre Plus Office.
Prisoners on Release Prisoners on release and those released from secure
accommodation (secure accommodation is defined as a court, a secure training centre or a secure children’s home) who present an FP10 or FP10 (MDA).
The letters ‘HMP’, and the prison or secure accommodation address and telephone number must be printed in the box provided for the practice address on the front of the form, along with the prescribing code and the cost centre code for the organisation. N/A

Ineligible reasons for exemption

PSNC sometimes receives queries about the following criteria and we would just like to clarify that these reasons are NOT eligible for exemption from prescription charges in England:

  • Those receiving incapacity benefit or the contribution based Jobseeker’s allowance.
  • Asylum seekers – they are instead supported by the National Asylum Support Service (NASS) who will automatically send an NHS Low Income Scheme HC2 certificate which entitles them to full help with help costs including free prescriptions. Alternatively patients can apply for support using the HC1 application form.

EPS exemption status to be entered onto each electronic prescription

In addition to the current endorsing information, pharmacy staff will also have to mark whether a prescription charge was levied for a prescription, and where relevant the prescription charge exemption category and whether evidence of exemption was seen. The exception to this is where the patient is age exempt and the patient’s date of birth is included in the electronic prescription message.

Pharmacy system suppliers have flexibility in the way they support pharmacists in entering this information, for instance if pharmacy staff have already recorded the details of a valid exemption certificate, e.g. a pre-payment certificate, the system could be set to pre-populate this information on the system – the pharmacy would still be required to collect the patients exemption declaration on the prescription or dispensing token where required.

See more at our EPS exemption page or in the factsheet below:

EPS exemption (PSNC HSCIC) thumbnail


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.


Where to find information about patient charge exemption certificates

 Information required about…

 Who to contact

FP57 forms See page Where to obtain external resources
NHS Low Income Scheme NHS Help with Health Costs: 0300 330 1343 or 0191 279 0565
Prescription pre-payment certificates (PPC) The Pricing Authority: 0300 330 1341 or 0191 279 0563
Medical and Maternity exemption certificates The Pricing Authority: 0300 330 1341 or 0191 279 0563
NHS Tax Exemption Certificate NHS Help with Health Costs: 0300 330 1347 or 0191 279 0567
HC1 (low income scheme) details and related forms See page Where to obtain external resources

Prescription Exemption Checking Service

NHS Prescription Exemption Checking Service: 0300 330 9291

You can also visit the Help with Health Costs website here.


FAQs

Q. Are young people aged 16, 17 or 18 on apprenticeships automatically exempt from prescription charges?

No. Whilst there is an exemption for those who are 16, 17 or 18 in full-time education, NHS Help with Health Costs have confirmed that apprenticeships do not qualify for free prescriptions. Full-time education means you must be receiving full-time instruction from a recognised educational establishment, such as a school, college or university.

However patients aged 16, 17 and 18 undertaking an apprenticeship who are on a low income are able to apply for help with their health costs using the HC1 form. If they are successful with their application, they will receive an HC2 certificate which would entitle the patient to receive free prescriptions.

More information on Help with Healthcare costs is available here.

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. A person has presented a prescription and made a declaration that they are exempt from paying a prescription charge. I have asked them to produce satisfactory evidence of such entitlement, but they do not have it with them. Do I need to do anything else apart from ticking the “evidence not seen” box on the prescription?

Yes. From 1st July 2016, the Terms of Service are amended to require pharmacy contractors, before supplying the drug or appliance, to advise the person who has been asked to provide the evidence of entitlement to exemption that NHS checks are routinely undertaken to verify that persons are exempt from payment of NHS prescription charges as part of the relevant arrangements for preventing or detecting fraud or error.

Q. How can I use my PMR system to check and amend EPS Release 2 exemptions to avoid switches and payment issues?

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

PMR systems should assist users by (1) preventing prescriptions being sent to the Pricing Authority unless an exemption category option has been selected; and/or (2) where needed, asking whether either, the ‘paid’ status is right, or, if instead, the category needs adjusting.

EPS prescriptions should also be able to have their exemption status amended at any time after claim notification has been sent, and the EPS prescription has been sent to the Pricing Authority, as long as the prescription’s relevant ‘5th of the month’ pricing deadline has not passed (see EPS five day window logic). NHS Digital has made amendments to the Spine to allow this functionality to be implemented and one PMR system already has this functionality available to users according to NHS Digital information.

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

 


Related resources

Dispensing Factsheet: Checking Prescription Exemption Status

EPS exemption

Switching

Prescription charge refunds

What does the patient pay?

Prescription Charge Card and Multi Charge Card

Is this prescription form valid?

Who can prescribe what?

Controlled Drug prescription forms and validity

How to identify prescriber codes

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



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