Opinion: Rethink which conditions get free prescriptions in England

PillsPrescriptions have risen to £8.05. Now, you get free prescriptions if you’re on benefits, a child, student or over-60. But there’s a list of illnesses that also give you free prescriptions for everything. Besides adding in cancer, this list was last updated in 1968.

The list ignores the fact that today, prevention is central to healthcare. Many drugs are now used to stop people developing heart conditions or strokes. It disregards treatable conditions like asthma or high blood pressure, where these drugs help keep patients out of costly hospitals. It needs a rethink.

Prof Ian Gilmore reviewed charges for the last Government. He suggested moving from a fixed exemption list to broadly covering long-term conditions.

Take the asthmatic lady who came in to see me.

She takes a reliever inhaler to beat flare-ups and a daily preventer. It costs her £24.75 – 8% of her weekly income. She doesn’t know how many times she needs a reliever, so she doesn’t buy a prepay certificate (£29 for 3 months).

So she decides not to buy the preventer, as her asthma’s been fine up until now – leading to an unexpected admission costing hundreds.  AsthmaUK found cost meant 34% of those who paid for drugs sometimes went without. Ipsos Mori found 800,000 didn’t collect prescriptions due to cost.

The current system also leads to waste. GP’s give a month’s supply so there’s just “one charge”, when giving a week’s supply plus a prescription for next week “if you need it” would be better.

However, the Coalition won’t extend free prescriptions to chronic conditions or change the exempt illnesses list. Charges raise £450 million.

There’s another anomaly – a person exempt because of, say, an underactive thyroid (treated with hormones) gets all other medications free. Yet France offers differential reductions of 35-100% for medications based on what conditions they can treat. Here, we manage to make birth control free, while managing to charge for contraceptives used for acne.

Some say reforms will lead to more prescriptions. Yet there was no abnormal increase in Wales. Instead more people, especially low to middle earners, collected medications they were prescribed.

One solution is to broaden how many chronic conditions are exempt – but balance this by charging for such “free” conditions, say, £3 per item. People don’t know in advance how much medication they’ll use that year – so a per-patient annual cost cap (monitored by your GP) over which all prescriptions are free could also help.

I’m not arguing for free prescriptions for all – it’s right that those who can pay, and are relatively well, should. But the current system is inefficient and inconsistent. It assumes over-60’s uniformly suffer from multiple conditions, granting them blanket exemption regardless of finances or health. It frees those with just one ‘special’ condition on an outdated list from having to pay for their other drugs.

It needs a rethink to fit the modern era of preventative medicine.


* Dr Mohsin Khan is the Chair of Lib Dem Campaign for Race Equality. He is also a directly elected member of Federal Policy Committee

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  • I’m not entirely sure I agree. If you need prescription regularly you can pay for a prepayment card, which makes all prescriptions free at the point of collection. It’s £104 per year, the cost of which can be spread over 10 months (so you pay £10.40 per month for 10 months of the year for a one-year card). That’s £2 per week.

    That said, personally I think all prescription charges should be scrapped. We don’t charge people to see their GP or stay in hospital overnight, why should we charge them to get medicine?

  • In addition to Wales, the Scottish experience of free prescriptions may be instructive. The argument is that free prescriptions reduces the overall cost of NHS Scotland by increasing prevention, reducing admissions etc .

  • Caron Lindsay Caron Lindsay 6th May '14 - 3:51pm

    Hireton, I’m not sure there is yet any actual evidence to back that up. I’d be interested if there was. I just find it frustrating that we are really struggling in Scotland to staff our hospital wards with nurses when an extra £40 million from prescription charges might help resolve that problem.

  • Caron, you’re loyal to a fault. Prescription charges might be Lib Dem policy but one of the reasons the SNP became so popular was because they chose to make certain things free in Scotland that were starting to be charged for in England. It was a populist policy, but it’s only by becoming popular that politicians can get the votes to form a government and attempt change society in the way they would prefer.

    Of course there’s always an opportunity cost in public spending decisions, and money used to grant free prescriptions could be spent on other things, but sometimes politicians have to compromise a little bit to gain acceptance from the electorate.

    Perhaps if the Lib Dems listened a little more to what the public wanted to pay for and what they didn’t then they might not be in their current predicament.

  • Julian Dean 6th May '14 - 6:22pm

    The current system is baffling, why do patients with diabetes or epilepsy for example get free prescriptions whereas if you suffer from life term diseases such as Crohns or Colitis you’re not entitled?

  • Nonconformistradical 6th May '14 - 6:39pm

    This could be another situation where a general benefit for the elderly needs looking at. Is there really a justification for exempting all people over 60 from paying prescription charges?

    Many people will have experienced clearing up after the death of an elderly person and taking carrier bags full of unused medications back to their GP. Did that person really need all that stuff to be prescribed in the first place?

    Agree it would be sensible to review the list of prescription charge-exempt conditions. But in these days, with people living much longer there seems a case for raising the exemption age upwards from 60 – or maybe having a scheme where total annual payments on non-exempt prescriptions are capped in some way for over 60s – yes – I know – it would need an appropriate IT system to handle people going to different pharmacies on different occasions etc.

  • @g

    “Perhaps if the Lib Dems listened a little more to what the public wanted to pay for and what they didn’t then they might not be in their current predicament.”

    Very easily said, but what are you saying we should actually cut to pay for this? What don’t “the public” want the government to pay for precisely?

  • First off nothing is ‘free’. Like ‘free’ car parking ‘free’ prescriptions have to be paid for by someone and as the government hasn’t actually got any money it’s down to tax payers. Speaking as someone who now gets ‘free’ prescriptions after having to pay for them for many years, I would be happy for the current system to be scrapped and, say, a £1 handling charge introduced on all prescriptions. That would still make them 60% cheaper than a box of over the counter branded ibuprofen which people seem happy to pay for.

  • Is there any evidence of the effect of free prescriptions on NHS spending in Wales? As others have said, my suspicion is that free prescriptions saves the NHS money over all, because so much medication (particularly long term medication) is used to prevent problems, but it would be really useful to have evidence from Wales of whether this has turned out to be the case.

  • Alex Baldwin 7th May '14 - 4:53pm


    If your income is that low you may still be entitled to exemption under the Low Income Scheme.

    “Q. Are students automatically entitled to free NHS treatment?

    A. Students in full-time education who are under the age of 19 are automatically entitled to full help with health costs (except travel costs, in which case they can apply to the Low Income Scheme).

    Students aged 19 and over entering higher education generally have access to their own resources and are no longer classed as dependant children. They can apply to the Low Income Scheme, using form HC1, the same as all other adults to see if they qualify for help. Telephone 0300 123 0849 to order an HC1 application form.”

    This should be much better publicised to students.

  • Alex Baldwin 7th May '14 - 4:58pm

    I am curious about the relationship between the NHS prescription charge and the prices that the drug companies are charging. When I worked in a pharmacy we would (where we were allowed to) sell any medicines that cost less than the prescription charge to the patient directly (thus saving them money). For medicines that cost more than the charge or were restricted to be sold only with a prescription though I have no idea what the prices charged to the NHS were.

  • Mohsin Khan 11th May '14 - 6:39pm

    Thanks for the responses. Two quick points:

    1. Why a maximum cap would be better than a prepay:
    With a prepay certificate you need to know, essentially in advance, that you’re going to spend more than £104 a year on prescriptions. If you buy a prepay you can only get a refund on your last month’s worth of meds (if you’ve kept the receipts etc).

    Not everyone knows in advance how ill they’re going to be – so the prepay system isn’t ideal. Even with a direct debit, it’s quite cumbersome to have to predict how much medicine you might need – you may fear buying a PPC and then not having to use it.

    The low income exemption scheme is also quite complicated – the form asks a lot of information which some can find tricky to complete.

    2. Currently, in England, prescription charges means there’s a lot of revenue coming from a small percentage of prescriptions (i.e. 10% of all).

    I’m not saying you do away with that revenue – I’m saying is it possible to rejig that system so it better suits modern approaches to healthcare and long term conditions – in a fair but financially sustainable (stronger economy, fair society!) way.

    The “Government report that 90% of prescription items are dispensed without charge, but up to three quarters of those of working age with long-term conditions are believed to pay for their prescriptions”. (http://www.publications.parliament.uk/pa/cm201314/cmhansrd/cm130710/debtext/130710-0005.htm)

    Also, some of the exemptions cover much more than, looked in the round, might be appropriate eg free maternal dental care a year after pregnancy while people with high blood pressure are entirely ignored. It’s outdated.

  • Mohsin Khan 12th May '14 - 7:08am

    Also, the Commission on the Future of Health and Social Care in England (King’s Fund) found that limiting free prescriptions to poorer pensioners could save ~ £1.5 billion.

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