Exemptions from the prescription charge

Exemptions from the prescription charge

QUICK LINKS

REF: Drug Tariff Part XVI
EPS exemption
Dispensing Factsheet: Exemptions from the prescription charge
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.


Eligible reasons for exemption

Exemption category

Who is exempt?

Proof required

How to apply for exemption

A. Under 16 years of age Children under 16 years of age.

Birth certificate, passport or medical card.

Please note: Prescriptions with computer-generated DOB do not require proof of age.

N/A
B. Full-time Students aged 16, 17 or 18

Must be aged 16, 17 or 18 and in full-time education from an establishment such as a school, college or university or similar.

Please note: Apprenticeships are not eligible. (However, patients may qualify for a HC2 certificate under the NHS Low Income Scheme)

Proof of age can be found on a child benefit award letter, or birth certificate /passport/medical card and proof they are a full-time student can be obtained from the patient’s school, college, university or local education authority (LEA). N/A
C. 60 years of age or over  Any patient who is 60 years of age or over.

Birth certificate, passport or medical card

Please note: Prescriptions with computer-generated DOB do not require proof of age.

N/A
D. Maternity Exemption  Expectant mothers and those who have given birth to a child (including a still-born child) in the last 12 months.

Possession of a valid Maternity Exemption (MATEX) certificate.

Please note: Prescription Services are currently trialing digital maternity exemption certificates. Pharmacies may be presented with one of the following types of exemption certificate:
• Digital certificate
• Printed copy of the certificate
• Plastic exemption card
For more information click here

Patient must complete a FW8 form available from GPs, midwives or health visitors. These professionals then sign the form and send it off to Prescription Services who then issue a certificate.
Maternity exemption certificate helpline: 0300 330 1341
E. Medical Exemption Patients with certain medical conditions or physical disability as listed in Part XVI of the Drug Tariff.

Possession of a valid Medical Exemption Certificate.

Please note: Patients with qualifying conditions alone are not entitled to exemption without a valid certificate.

 

Patients must complete an FP92A form available from GPs. The GP will then send the form to Prescription Services who will issue a certificate.
Medical exemption certificate helpline: 0300 330 1341
F. Prescription Pre-payment Certificate (PPC) 

Patients in possession of a valid PPC at the point of dispensing.

Please note: A PPC is valid for either 3 months or 12 months, depending on the type of PPC purchased.

Possession of a valid PPC.

Please note: Prescription Services are working to phase out plastic cards and move towards digital certificates for PPCs.
For more information see our website here.

Patients can complete an FP95 form, available from pharmacies and purchase in store (for pharmacies registered to sell PCCs) or via post (postage details can be found on the FP95).

Patients can also purchase a PPC online here or by contacting the
PPC helpline: 0300 330 1341

G. War Pension Exemption Patients holding a War Pension Exemption Certificate and the prescription is for their accepted disablement. Possession of a War Pension Exemption Certificate. Patients can write to:
The Treatment Group
Veterans UK
Norcross
Blackpool
FY5 3WP
Veterans UK helpline: 0808 1914 218
L. HC2 Charges Certificate Anyone qualifying for full help with health costs through the NHS Low Income Scheme.

Possession of a valid HC2 Charges Certificate.

Please note: A partner and dependent children under 19 years named on the claim will also be entitled to free prescriptions while the certificate is valid.

Patients must complete the HC1 form, available from Jobcentre Plus Office, forms may also be available from pharmacies, NHS hospitals, dentist, optician or GP surgery. Pharmacies can obtain HC1 forms from PCSE via their online portal.
NHS Low Income Scheme helpline: 0300 330 1343
X. Free-of-charge contraceptives Patients in possession of a prescription for a contraceptive substance(s) and/or listed contraceptive appliances for women (as referenced in Part XVI Clause 10 of the Drug Tariff) prescribed on FP10 or any of its variants.

No charge is payable for contraceptive substances and listed contraceptive appliances for women (as referenced in Part XVI Clause 10 of the Drug Tariff) prescribed on FP10 or any of its variants.

Please note: Prescriptions for any other drug not included in the list of contraceptive drugs to be dispensed free of charge must be annotated by the prescriber with ‘CC’, ‘CU’, ‘OC’ or the female symbol ♀. In the absence of such an endorsement by the prescriber and where the patient does not have another valid exemption, the normal prescription charge will apply to that item.

N/A

H. Income Support (IS) 

 

or

Income-related Employment and Support Allowance (ESA)

Patients in receipt of IS or those included in (this could be the partner of or any dependent young people under 20) an award for IS.
Possession of an IS award notice
Patients can speak to their Jobcentre Plus Office or contact Jobcentre Plus helpline: 0800 169 0310
Patients in receipt of income-based ESA or those included in an award for ESA – this could be the partner of or any dependent young people under 20. Possession of an ESA award notice
Patients can speak to their Jobcentre Plus Office or contact Jobcentre Plus helpline: 0800 169 0310

K. Income-based Jobseeker’s Allowance (JSA)

 

or

Universal Credit (UC)

Patients in receipt of income-based JSA or those included in an award for JSA – this could be the partner of or any dependent young people under 20. Possession of a JSA award notice Patients can speak to their Jobcentre Plus Office or contact Jobcentre Plus helpline: 0800 169 0310

Patients in receipt of UC.

Please note: UC does not automatically entitle patients to help with their health costs. To qualify, patients must be included in a UC award and their earnings during their most recent assessment period must be:
• £435 or less
• £935 or less if their UC includes an element for either a child or limited capability for work

‘Most recent assessment period’ means the assessment period that ended immediately before the date a patient claims a free NHS prescription. It runs for a calendar month.

Possession of a Universal Credit statement.

Please note: Patients should tick the box K for ‘income-based JSA’ on the patient declaration until the prescription form is updated to include an exemption category for UC.

 

Please see our page Universal Credit update. Further information can be found here.
Universal Credit full service: 0800 328 5644
Universal Credit live service: 0800 328 9344
M. NHS Tax Credit Exemption

Patients (including any partner and/or young person(s) included in the claim) receiving tax credits, who have been sent ‘NHS Tax Credit Exemption Certificate’ by Prescription Services.

Please note: To be entitled to a Tax Credit Exemption certificate, the patient and their partner (if applicable) must:
have a combined annual income for Tax Credit assessment purposes of £15,276 or less, and;
be in receipt of Child Tax Credit and/or receive a disability element of Working Tax Credit*
*Receiving Working Tax Credit alone (no disability element included) does not entitle patients to help with health costs, regardless of their annual income.

 

Possession of a valid NHS Tax Credit Exemption Certificate.

Please note: Prescription Services are working to phase out plastic cards and move towards digital certificates. In the interim pharmacies may be presented with one of the following types of exemption certificate:
• Double-sided A4 paper certificates
• Plastic exemption cards

For more information see our website here

Certificates are automatically issued to eligible patients.
Tax Credit helpline: 0345 300 3900
S. Pension Credit (Guarantee Credit) paid on its own, or Pension Credit (Guarantee Credit with Savings Credit) Patients or their partners in receipt of PCGC. Possession of a PCGC award notice. Patients can speak to their Jobcentre Plus Office.
Pension Service helpline: 0800 731 0469
Other exempted persons/categories
Prisoners on Release Prisoners on release and those released from secure accommodation (e.g. courts, training areas or children’s home) who present an FP10 or FP10(MDA) with the letters ‘HMP’ computer printed in the practice address box.

The letters ‘HMP’, the prison/secure accommodation address, contact number, prescribing code and cost centre code must be computer printed in the box provided for the practice address.

Please note: if the above is handwritten, it cannot be accepted as automatically exempt.

If the necessary information is on the prescription then the patient is classed as automatically exempt and does not need to sign or tick the declaration on the back of the form.

N/A


Ineligible reasons for exemption

Those in receipt of the following benefits are not eligible to claim for exemption from prescription charges in England:

  • Contribution-based Jobseeker’s Allowance and Employment and Support Allowance paid on its own;
  • Pension Credit (Savings Credit), paid on its own;
  • HC3 certificate for limited help with health costs;
  • Any benefit paid on its own and not listed on the back of a prescription (such as Disability Living Allowance, Personal Independence Payment or Incapacity benefit); and
  • Asylum seekers – instead supported by the National Asylum Support Service (NASS) who will automatically send an NHS Low Income Scheme HC2 certificate entitling them to help with health costs including free prescriptions. Alternatively, patients can apply for support using the HC1 application form.

For a full list of benefits that do not entitle patients to exemption from the prescription charge see Prescription Services website here.

 


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: Exemptions from the prescription charge

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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