Prescription charges

Hitiris, T. (2000), Prescription charges in the United Kingdom a critical review , University of York, Department of Economics and Related Studies discussion papers in economics No 00/04, York. 

Lavers, R. (1989), Prescription charges, the demand for prescriptions and morbidity Applied Economics, 21, 1043-52. 

Walley, T. (1998), Prescription charges change overdue , British Medical Journal, 317, 487-8. 

In some mainly rural areas the doctor may also dispense the medicines prescribed, but more usually the patient takes the prescription to a community pharmacist, also under contract with the NHS, who dispenses the medicines and claims reimbursement at predetermined rates. Unless they are exempt, patients pay a prescription charge at the time of dispensing. 

For a short period between 1965 and 1968, under the Labour government of Harold Wilson, prescription charges were abolished. In 1968, however, charges were reintroduced and the concept of exemptions was introduced. 

In 1971, when the prescription charge was 0.20, the proportion of prescriptions that were exempted was 52% of the total of these, 32% were for the elderly (men over 65 and women over 60) and 20% were for non-age related reasons. In 1995, 89% of prescriptions were exempt from charge, 45% on grounds of age, which means that 44 % of prescriptions were exempt from charge for non-age related reasons. 

The list of grounds for exemption from a prescription charge in the United Kingdom is extensive. The social grounds are low income, children below the age of 16 years, people in full-time education up to 19 years of age, pregnant women and women in the puerperium following either a live or still birth, old age (women over 60, men over 65, but since October 1995 men over 60) and war pensioners. 

In addition, for social policy reasons, since July 1975 prescriptions for oral contraceptives have also been exempt from charges. The medical grounds for exemption from prescription charge are diabetes mellitus, diabetes insipidus, hypopituitarism, hypothyroidism, hypoparathyroidism, hypoadrenalism, myaesthenia gravis, epilepsy and permanent fistula, for example colostomy, ileostomy. In addition, police personnel can claim back from their employing authority any prescription charge they incur. 

There are illogicalities in the system, as a patient who is exempt from paying a prescription charge gets all medicines free, even if the... 

In October 1995, the European Court of Justice in Luxembourg ruled on equal treatment for men and women regarding the age at which they should be exempted from paying an NHS prescription charge. Until then the exemption from the prescription charge had been linked to the state pensionable age of 60 years for women and 65 for men. Men are now exempt from the age of 60, at an estimated cost of 30 million per year in 1995 for lowering the age and 10 million for refunds for those men between 60 and 65 years who had paid for a prescription in the preceding 3 months. ... 

Another criticism of the current level of prescription charges is that in 1994, nearly 60% of prescribed medicines could either be purchased from a pharmacist for less than the prescription... 

Both physicians and economists, have called for reform of the prescription charge exemptions for both social and medical conditions. It has been pointed out that if the exemptions were reduced from 89% to 55% - the level that applied when they were first introduced - and the charge actually reduced to 2.50 per item, then 250 million per annum extra could be collected at the 1995 prescribing level of 500 million items per year. Changes in the current system would not only have to be logical but politically acceptable, and there is no indication that the political will to introduce changes is growing. 

Rationalisation of the exemptions from prescription charges and a variation of the current season ticket scheme linked to annual registration with a general practice have been proposed. ... 

The rate of nonpresentation (or redemption) of prescriptions (UK) is around 5% but up to 20% or even more in the elderly (who pay no prescription charge). Where lack of money to pay for the medicine is not the cause, this is due to lack of motivation. 

Many factors are associated with prescription nonredemption. Perhaps the cameo of a person least likely to redeem a prescription is a middle-aged woman, not exempt from prescription charges (in UK National Health Service) who has a symptomatic condition requiring an acute prescription that is issued by a trainee general practitioner on a Sunday (Beardon P H G et al 1994 British Medical Journal 307 846). 

Fully reimbursed bcisic treatment drugs or essential drugs (137 active substcmce groups) patients pay the fixed prescription charge, the same price for all drugs from this list. 

This box is completed by the pharmacist or pharmacy technician at the same time as the prescription form is stamped at the top left-hand corner. The figure entered into this box will be the total number of prescription items on the form. This figure will include any items which attract more than one prescription charge (e.g. surgical stockings, some HRT, etc.). For further details on prescription charging, see Section 2.4.1). 

On the reverse of the prescription form, the patient or the patient s representative will complete the form to indicate whether the patient is exempt from prescription charges (and if so, what exemption they are declaring) or an indication of the number of prescription charges paid (see Figure 2.2). 

In England, one prescription charge is payable for each prescription item. This charge is fixed and is irrespective of the cost of the item or the number of dosage units. 

This is important as the pharmacy is acting on behalf of the NHS in collecting the prescription charges. As the pharmacy will keep these charges, the Prescription Pricing Division will deduct the amount collected from the monies it will pay to the pharmacy at the end of the month. This deduction will be based on what the pharmacy should have collected, irrespective of what they did collect. Therefore, if a pharmacy does not take the correct number of... 

There are a number of situations where a single prescription item will attract more than one prescription charge. Student pharmacists and pharmacy technicians should study this part of the Drug Tariff and become familiar with the different charging models. 

Single prescription charge payable The same drug or preparation is supplied in more than one container... 

Multiple prescription charges payable Different drugs, types of dressing or appliances are supplied... 

The patient is not exempt from paying prescription charges. How many prescription charges should you take ... 

This part contains information on the NHS prescription charging system and is similar in composition to Part XVI of the Drug Tariff for England and Wales (see Section 2.4.1). As in Scotland (see Section 2.4.3), there has been talk in Northern Ireland of abolishing prescription charges altogether. 

At the end of the month, all NHS prescription forms are sorted into two main groups (exempt from prescription charge and prescription charge paid) and then by prescriber type (doctor, dentist, etc.) and finally by individual prescriber,... 

If a medicine is supplied using a Patient Group Direction under NHS guidelines, a prescription charge will be levied and if outside the NHS, a charge will be made but this will not be subject to VAT. 

Ask prescriber to provide a new prescription or (if the patient is not exempt from prescription charges) as this item is available for purchase from pharmacies (a P medicine - see Section 1.3.2), offer to sell the item to the patient. 

The layout of an FP10PCD can be seen in Figures 6.1 and 6.2. The key difference from an ordinary FP10 (or equivalent) prescription form (see Section 2.2.6) is the absence on the rear of the form of the section for the patient to complete to indicate whether they are exempt from prescription charges. This is because the form is a private prescription form and as such the patient will be charged to cover the cost of the medication and supply. 

Date of supply Emergency supply at the request of Dr Smith John Fulbright Dr Smith 27 Station Rcad The Health Centre Anyftwn Anytoron 21 Amoxicillin 250 my capsules 1 TDS Date on prescription form Date prescription form received Prescription charge (NHS or private) or details of exemption (NHS). 

The patient may need to pay for the medication, but this will depend on the type of prescription form to be supplied. If the prescription form that will follow is an NHS prescription form, there will be either no charge to the patient for the supply (if the patient is exempt from prescription charges) or the standard prescription charge amount will be levied. If the prescription form that will follow is a private prescription form, this will be charged as for any private prescription form (see Section 5.1). 

In this case, the patient could simply complete the form in the pharmacy. Then, when the prescription form arrives, the pharmacist can indicate that a charge was collected (for each item) and refunded by processing the form as usual, along with the prescription charge receipt and refund claim form. 

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