How do prescription charges and exemptions work?
England charges a flat fee per item, with extensive exemptions — and the rest of the UK charges nothing, which is the difference most people are unaware of until they move.
The four-nation position:
England — a flat charge per item, not per prescription. A prescription for three medicines costs three times the charge.
Scotland, Wales and Northern Ireland — prescriptions are free for everyone.
Who is exempt in England, in outline:
Age — under 16, 16 to 18 in full-time education, and 60 or over.
Maternity or medical exemption certificate holders, covering pregnancy and the year after birth, and a specified list of long-term conditions. The medical exemption list is narrow and has been criticised for decades as arbitrary — it has changed little since it was drawn up, so some serious long-term conditions requiring lifelong medication are not included while others are.
Certain benefits, and the NHS Low Income Scheme for those on low income who do not receive qualifying benefits.
War pension exemption, for the accepted disability.
Hospital inpatients, and some contraceptive and treatment categories.
The prescription prepayment certificate (PPC). For anyone paying who needs more than a few items, a PPC covers unlimited prescriptions for three or twelve months for a fixed sum. It pays for itself at a small number of items, and can be paid by instalments — and a great many people who would benefit do not have one, simply because they do not know it exists.
Checking eligibility matters. Incorrectly claiming an exemption results in a penalty charge plus the original cost, and checks are automated and routine. Conversely, people entitled to exemption frequently pay unnecessarily.
What is not covered by the charge: some items are dispensed free regardless, and medicines administered in hospital are not charged.
Cheaper over the counter. Some medicines cost less to buy than the prescription charge — asking the pharmacist is worthwhile, though this does not apply where you are exempt.
Dental and optical charges operate on separate systems with their own exemptions.
General information — check current charges and eligibility.