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Pharmaceutical Services Negotiating Committee

Prescription Charges and Exemptions

The NHS Prescription Charge in England will change to £7.85 from 1st April 2013.

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Prescription Charge Card


Whenever there is an increase in the NHS Prescription Charge in England, PSNC produce a pharmacy display card which can be used to inform customers of the rise. It is distributed to
 all pharmacy contractors in England.

Prescription Charge Card (effective 1st April 2013)

The 2013 version of the prescription charge card is currently being sent out to all community pharmacies (in March's edition of Community Pharmacy News).


Exemption from Prescription Charges


Part XVI of the Drug Tariff (Notes on Charges) sets out the categories of people who are entitled to exemption or remission from the prescription charge. In April 2008 there was a change to the requirements to exempt certain prisoners on release from prison from the prescription charge.

Detailed guidance on the exemption categories and the proof that patients should be asked to show of their entitlement to exemption is available in the Point of Dispensing Checks section of this website.

Part XVI of the Drug Tariff also sets out the arrangements for 'No Charge Contraceptives'. Prescriptions for contraceptive devices listed in Part IXA of the Drug Tariff, spermicidal gels, creams, films and aerosols are automatically exempt from the prescription charge. As are systemic drugs which are promoted as contraceptives and which are listed in Part XVI of the Drug Tariff.

In addition to this, no prescription charge should be levied if the prescriber has marked the prescription to make it clear that the prescription is for contraceptive use. For example co-cyprindiol 2000mcg/35mcg tablets are used in the treatment of severe acne, however patients receiving this medicine shouldn't be given additional hormonal contraception as it would expose them to an excessive dose of hormones. If the doctor has endorsed the prescription with the female symbol (♀) or endorsed the prescription in another way which makes it clear that the item is for contraceptive use, the patient should not incur a prescription charge. If a pharmacy receives a prescription for this product without an indication that it is for contraceptive purposes, a prescription charge should be levied.

Where to find information about different patient charge exemption certificates:

 Information required about...

 Who to contact

FP57 forms

 Your PCT

NHS Low Income Scheme

NHS BSA on 0300 330 1343 or 0191 279 0565

Pre-payment certificates

NHS BSA on 0300 330 1341 or 0191 279 0563

Medical and Maternity exemption certificates

NHS BSA on 0300 330 1341 or 0191 279 0563

NHS Tax Exemption Certificate

NHS Forms 0300 330 1347 or 0191 279 0567

HC1 (low income scheme) details and related forms

NHS Forms Orderline on 0845 610 1112

 


How many Charges?

Part XVI of the Drug Tariff, Section 11, Notes on Charges Payable, lists the rules which govern single prescription charges and multiple prescription charges.

Unless the patient claims exemption, a single prescription charge is payable where:

  • The same drug or preparation is supplied in more than one container.
  • Different strengths of the same drug (in the same presentation) are ordered as separate prescriptions on the same prescription form.
  • More than one appliance of the same type (other than hosiery*) is supplied.
  • A set of parts making up a complete appliance is supplied.
  • Drugs are supplied in a powder form with a solvent separate for subsequent admixing.
  • A drug is supplied with a dropper, throat brush or vaginal applicator.
  • Several flavours of the same preparation are supplied.

Unless the patient claims exemption, multiple prescription charges are payable where:

  • Different drugs, types of dressings or appliances are supplied.
  • Different formulations or presentations of the same drug or preparation are prescribed and supplied.
  • Additional parts are supplied together with a complete set of apparatus or additional dressing(s) together with a dressing pack.
  • More than one piece of elastic hosiery (anklet, legging, knee cap, below knee, above knee or thigh stocking) is supplied.

 

Dispensing Resources BkletPSNC Alphabetical List of Charges

Each year, the PSNC Information team product a Dispensing Resources Booklet which includes an alphabetical guide to prescription charges. The booklet can be downloaded by clicking on the link below:

Dispensing Resources 2008/09 (PDF Format)

The new version of Dispensing Resources (2012 edition) has been sent out to all community pharmacies.

 


Multi Charge Card

PSNC also publish a card that lists some commonly dispensed products which incur no prescription charge or multiple prescription charges. The Multi Charge Card has been designed to be a quick reference guide that can be used on the counter or as a poster. Click on the link below to download a copy of the card.

Multi Charge Card 

 


Welsh FlagWales

On the 1st April 2007, prescription charges were abolished for people living in Wales.

Patients with WP10 prescriptions or FP10 prescriptions and a Welsh prescription charge entitlement card will not have to pay for their prescriptions at Welsh pharmacies. Patients who present FP10 prescriptions in Wales without an entitlement card will be subject to a prescription charge per item unless the patient is entitled to exemption.

Exemption certificates are available on application to the BSC for those patients who are exempt on medical or maternity grounds and would prefer to have their prescription dispensed outside of Wales. In England, all prescriptions, including Welsh WP10 prescriptions are subject to the standard English prescription charge unless the patient is entitled to exemption.

Pre-payment certificates issued in England for patients registered with a GP contracted to an English PCT are still valid in Wales when presented with an FP10 prescription.

Patients presenting a Welsh prescription form (WP10 series) at a pharmacy in Wales no longer have to sign the reverse of the prescription form to prove exemption from charge. Patients presenting English prescription forms continue to be required to make the declaration.

 

Northern Ireland

On 1st April 2010 prescription charges were abolished for people living in Northern Ireland. In summer 2010 the Department of Health announced changes to the prescription charge arrangements in England for NHS prescription forms originating from Northern Ireland. From 1st August 2010, any patient who presents an NHS Northern Irish prescription form (coded HS21CS) will not pay a prescription charge for any items on that form that are dispensed in England.

Following the abolition of prescription charges in Northern Ireland on 1 April 2010, a new prescription form (coded HS21CS) has been in use in Northern Ireland. The form does not include a tick box and declaration section on the reverse of the form, but does include a signature box for those collecting controlled drugs. The previous version of the Northern Ireland prescription form may be in circulation for the time being. From 1st August 2010 both versions of the forms must be dispensed without collecting prescription charges. A patient or patient representative signature will not be not required on either version of the form (except in the case of schedule 2 & 3 controlled drugs when a collector's signature is still required).


Frequently Asked Questions

I collected a prescription via a prescription collection service on the 31st March 2012. The patient has collected the prescription from the pharmacy and signed the exemption declaration on the 1st April. Should the patient pay the prescription charge at the old or new rate?

There is no national guidance on this issue so pharmacy staff will need to use their judgement. PCTs will use the information on the back of the form (the prescription charge exemption declaration) to undertake patient prescription charge exemption fraud checks. It essential that when the patient signs and dates the back of the form, they are entitled to claim exemption or have paid the charge at the prevailing rate.  

I have a prescription for a patient who was 59 when his prescription was written, however the patient did not handover his prescription to be dispensed until he was 60. Is the patient exempt from paying a prescription charge? 

Yes, entitlement to prescription exemption is based on the patient's circumstances at the point of dispensing rather than on the date the prescription was written. In this case, as the patient was over 60 when they entered the pharmacy to have their prescription dispensed, they would be exempt from paying a prescription charge.

A patient has 3 items on their prescription, but only one item is eligible for his war pension exemption. How can I endorse the prescription to show this?

NHS Prescription Services has confirmed that the only way to process these items correctly is to request the prescriber writes 2 separate prescriptions; one for the item which the patient is going to claim on the war pension exemption certificate and the rest on the other prescription. The contractor will then be able to submit these prescriptions in the relevant exemption group. 

I have received an FP10 prescription for ‘a Nicorette inhalator starter pack and refill pack'. How many prescription charges should the patient pay? 

The patient would pay only 1 prescription charge (and the pharmacist would receive only one fee) as the same drug has been prescribed twice. The Inhalator itself is a ‘Non Drug-Tariff Appliance' but is allowed because it is packed with the drug (Nicotine Inhalator cartridge) and is required to enable the patient to take the medicine. More information is available in Part XVI of the Drug Tariff (10.11 Drugs Packed with Non Drug Tariff Appliances.)

I have received an FP10 prescription asking for ‘Ensure Plus various flavours'. If 6 different flavours are supplied, how many professional fees would I receive?

If the FP10 is ordered as ‘mixed, assorted or various flavours' and several flavours of the same preparation are supplied, you will receive professional fees equivalent to the number of different flavours supplied. The patient will pay only one charge regardless of how many flavours have been dispensed. If the prescription does not state ‘mixed, assorted or various flavours,' only one professional fee will be paid regardless of whether multiple flavours have been dispensed or endorsed.

How many prescription charges should be levied if both carbamazepine 200mg tablets and carbamazepine MR 200mg tablets are prescribed on the same FP10 prescription?

Where different formulations or presentations of the same drug or preparation are prescribed and supplied, multiple prescription charges are payable (see Part XVI, Clause 11.2 of the Drug Tariff).

In the carbamazepine example, as standard tablets and modified release tablets are different formulations, two prescription charges would be payable unless the patient was entitled to exemption or remission from the charge.

How many prescription charges should be levied if both diclofenac sodium 25mg gastro-resistant tablets and diclofenac sodium 75mg modified-release tablets are prescribed on the same FP10 prescription?

Where different formulations or presentations of the same drug or preparation are prescribed and supplied, multiple prescription charges are payable (see Part XVI, Clause 11.2 of the Drug Tariff).

In the diclofenac sodium example, as gastro-resistant tablets and modified-release tablets are different formulations, two prescription charges would be payable unless the patient was entitled to exemption or remission from the charge.

I have received an FP10 Prescription for two pairs of ‘Thigh Stockings - Class 2'. How many prescription charges should the patient pay and how many professional fees can I claim?

Prescription charges for elastic hosiery are calculated per garment (2 pairs of stockings = 4 garments) but professional fees are calculated per prescription item (2 pairs of stockings = 1 prescription item), therefore two pairs of stockings would incur four patient charges. The pharmacy contractor would receive one professional fee.  

Other than standard elastic hosiery, where more than one appliance of the same type is supplied such as a lymphoedema garment, only one prescription charge should be levied, for example a prescription for a pair of ‘Jobst Elvarex Custom Fit Class 1 Thigh High Stockings would incur one prescription charge.

Part XVI of the Drug Tariff, Section 11, Notes on Charges Payable, lists the rules which govern single prescription charges and multiple prescription charges. PSNC also publish a card that lists some commonly dispensed products which incur no prescription charge or multiple prescription charges. The Multi Charge Card has been designed to be a quick reference guide that can be used on the counter or as a poster.

I have received an FP10 prescription for 2 pairs of ‘Tubifast socks'. How many prescription charges apply?

These products are considered to be ‘stockinettes' rather than ‘elastic hosiery' and are listed as such in Part IXA of the Drug Tariff. The general rule is that only one charge is payable when more than one appliance of the same type (other than elastic hosiery) is supplied. Therefore, a prescription asking for 2 pairs of ‘Tubifast socks' would attract 1 prescription charge.

I have received an FP10 Prescription for one pack of ‘Moviprep' sachets. How many prescription charges should the patient pay?

Moviprep is a new macrogol compound bowel cleansing solution. This product consists of a pack of 4 sachets, packaged so that the pack contains two transparent bags each containing one ‘Sachet A' (containing macrogol, sodium sulphate, sodium chloride and potassium chloride) and one ‘Sachet B' (containing ascorbic acid and sodium ascorbate). Sachet A has to be dissolved together with Sachet B in 1000ml of water prior to administration.

When dispensing this prescription, one prescription charge should be levied and the pharmacy contractor would receive two professional fees. This product has been granted special container status.

I have received an FP10 prescription for ‘Onbrez Breezhaler 150microgram inhalation powder capsules with device’. How many prescription charges would the patient have to pay?

This item would incur 1 patient charge and 1 dispensing fee.

The Inhalator itself is a ‘Non Drug-Tariff Appliance' but is allowed because it is packed with the drug (Indacaterol) and is required to enable the patient to take the medicine. More information is available in Part XVI of the Drug Tariff (10.11 Drugs Packed with Non Drug Tariff Appliances.)

I have a prescription for Emla 5% cream. There is a pack that comes with occlusive dressings, if I dispense this what will I be reimbursed?

The requirements for prescriptions ordering the packs of Emla 5% cream with occlusive dressings have changed.

There used to be a pack known as a ‘pre-medication pack’, but this is no longer recognised by NHS Prescription Services. To keep in line with dm+d descriptions (which prescribers should be doing) prescriptions should be written as either:

Emla 5% cream 25g + 12 dressings

OR

Emla 5% cream 5g + 2 dressings

However, if a prescription is written simply as "Emla 5% cream", pharmacy contractors can still be reimbursed for dispensing any of the available pack sizes (including the dressings packs), as long as they endorse the prescription accordingly (using the descriptions given above).

Please note that the patient would pay only 1 prescription charge (and the pharmacist would receive only one fee) because the dressings are ‘Non Drug-Tariff Appliances' which are only permitted because they are packed with a prescribable drug and are required as part of the drug’s use. More information is available in Part XVI of the Drug Tariff (10.11 Drugs Packed with Non Drug Tariff Appliances.)

How many dispensing fees will I receive for dispensing an FP10 prescription for ‘Qlaira’?

Qlaira is a combination product which contains 5 different types of tablet; as such a pharmacy contractor would receive 5 professional fees for dispensing this item against an NHS prescription.

As Qlaira is recognised as a contraceptive drug an NHS prescription for this item would not incur a prescription charge.

If I receive a prescription for co-cyprindiol 2000mcg/35mcg tablets and it is being used for contraceptive purposes, does the patient need to sign the exemption declaration on the back?

Part XVI of the Drug Tariff also sets out the arrangements for 'No Charge Contraceptives'. Prescriptions for contraceptive devices listed in Part IXA of the Drug Tariff, spermicidal gels, creams, films and aerosols are automatically exempt from the prescription charge. As are systemic drugs which are promoted as contraceptives and which are listed in Part XVI of the Drug Tariff. Co-cyprindiol 2000mcg/35mcg tablets do not appear in these sections of the Drug Tariff so would not be automatically recognised as being used for contraceptive purposes.

However, no prescription charge should be levied if the prescriber has marked the prescription to make it clear that the prescription is for contraceptive use. We have used co-cyprindiol 2000mcg/35mcg tablets in our example which can be used to treat severe acne. 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. If a pharmacy receives a prescription for this product without an indication that it is for contraceptive purposes, a prescription charge should be levied.

I have received an FP10MDA instalment prescription for fourteen days supply with a total of 12 collections of methadone. How many prescription charges would the patient have to pay?

This item would incur 1 patient charge.

Unless the patient claims exemption, a single prescription charge is payable where the same drug or preparation is supplied in more than one container.

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