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Pharmaceutical Services Negotiating Committee

Points of Dispensing Checks Guidance

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Pharmacy staff are required to check at the point of dispensing (POD) whether patients have evidence of their entitlement to free prescriptions. These checks should be carried out at the time a patient signs the forms to declare that they do not have to pay NHS prescription charges.

If patients are unsure whether they are entitled to free prescriptions, they should be advised to pay for their prescriptions, given a receipt (Form FP57) and provided with information on claiming a refund at a later date.

Where patients do not have evidence or where there is doubt over whether the evidence provided is genuine or appropriate, the ‘Evidence not Seen' box on the back of the prescription should be marked with an X by pharmacy staff. Pharmacy staff should not refuse to dispense items on the basis that the patient does not provide evidence of their entitlement to free prescriptions. Pharmacy contractors are in no way responsible for the accuracy of a patient's declaration; this remains the responsibility of the patient. PCTs have responsibility for checking for prescription charge exemption fraud. Patients found to have wrongly claimed help from the NHS with the cost of their NHS prescriptions will face a penalty charge and in some cases prosecution.

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 evidence on each occasion to ensure their continued entitlement.

The proof required for each exemption category is outlined below:

Age Exempt Patients


Children under 16 years of age and men and women aged 60 years and over are entitled to exemption.

If the patient's date of birth is computer generated on the prescription or included in the electronic prescription message and the patient is under sixteen years of age or over sixty, the patient is not required to complete the exemption declaration. No evidence is required.

If the date of birth is hand-written or not printed on the prescription, the patient must complete the exemption declaration. Evidence that could be shown includes a passport, birth certificate, or any other official papers showing the patient's name and date of birth. For children under 16, if the child is obviously under 16, no evidence is required.

Full-time Students aged 16, 17 or 18 who are in Full-time Education


Evidence that should be shown is proof of the patient's date of birth (see above) and proof that the patient is a full-time student (e.g. Student Card or letter from school/college).

Proof can be obtained from the patient's school, college, university or local education authority (LEA).

Patients who have a valid Maternity Exemption Certificate


Pregnant women and those who have had a baby in the last 12 months get free prescriptions if they have a valid maternity exemption certificate.

If a pregnancy ends in a miscarriage before the 24th week of pregnancy, the maternity exemption certificate ceases to be valid. If the miscarriage occurs after the 24th week of pregnancy, the maternity exemption certificate remains valid until it's expiry date.

If a woman has had a stillbirth, she will still have entitlement to exemption from NHS prescription charges up to 12 months after the stillbirth. Generally, the patient will still hold an NHS Maternity Exemption Certificate; this is acceptable as evidence of exemption until the date of expiry. The patient should also have a certificate of stillbirth but is unlikely to carry it with her. If the patient is distressed or hesitant, remember that the patient is not obliged to produce evidence. Simply mark the ‘Evidence not seen' box.

To obtain a maternity exemption certificate, patients should complete Form FW6 which is available from GPs, Midwifes and health visitors. The GP, Midwife or Health professional will then sign the form and send it off to the NHSBSA.

The NHSBSA are responsible for issuing Maternity Exemption Certificates. More information is available on their website.

Patients who have a valid Medical Exemption Certificate


To claim exemption under this category, it is necessary for the patient to have a valid medical exemption certificate, not simply a medical condition. The list of conditions which would entitle a patient to a medical exemption certificate can be found in Part XVI of the Drug Tariff. Medical exemption certificates are typically, although not uniformly valid for 5 years.

To obtain a medical exemption certificate (MEDEX), patients should complete Form FP92A which is available from GP surgeries. The GP is required to sign the form and send it off to the NHSBSA.

The NHSBSA are responsible for issuing Medical Exemption Certificates. More information is available on their website.

Patients who have a valid Prescription Pre-payment Certificate


Appropriate evidence of exemption would be the certificate itself.NB. Patient may backdate their PPC up to one month from the date that they apply. If the patient intends to buy a PPC, they should be asked to pay for their prescription, provided with the FP57 Receipt and advised on how to obtain a refund. (Pharmacies can obtain copies of Form FP95 from their PCT).

The cost of prescription prepayment certificates from 1st April 2011 will be £29.10 for 3 months or £104.00 for 12 months (no change to price of certificates in April 2012).

Patients can obtain a prescription pre-payment certificate by completing Form FP95 which is available from pharmacies and doctors surgeries. Alternatively patients can order a PCC over the telephone with a credit or debit card (0845 850 0030) or on the internet (www.ppa.org.uk/ppc). Some pharmacies are registered to sell PPC's directly.

The NHSBSA PPD are responsible for issuing Prescription Pre-payment Certificates. More information is available on their website.

The patient is named on a current HC2 Charges Certificate


Appropriate evidence of exemption would be the certificate itself.Patients who are not entitled to help with health costs under any other category may apply for help under the NHS Low Income Scheme. Patients can receive either an HC2 (full help) or HC3 (partial help) certificate. HC3 certificates cannot be used to claim exemption from prescription charges.

Patients may claim for help with help costs under the NHS Low Income Scheme using Form HC1, obtainable from Jobcentre Plus Office or by calling 0845 850 1166. HC1 forms may also be available from the local hospital, dentist, optician or GP surgery. Pharmacies can obtain copies of Form HC1 by calling the DH publications order line (0300 123 1002).

The NHSBSA administer the NHS Low Income Scheme, more information is available on their website.

The patient or his/her Partner is entitled to, or named on, a valid NHS Tax Credit (TC) Exemption Certificate


Not all patients receiving tax credits are entitled to free prescriptions - those patients that are entitled are automatically sent an ‘NHS Tax Credit Exemption Certificate' by the NHSBSA. Appropriate proof of exemption would be the NHS Tax Credit Exemption Certificate.

Exemption certificates are sent automatically to eligible patients. Patients who are unsure as to whether they are entitled to help with health costs via tax credits, can contact HM Revenue and Customs for support: 0845 300 3900

The Patient or his/her Partner is getting Income Support (IS)


Note some letters and documents issued by the DWP about income support, while relating to the patient (or their partner) do not show dates of entitlement therefore these are not acceptable evidence.

Entitlement to income support may stop at any time and evidence is only acceptable where it confirms receipt of income support on the date the patient signs the prescription form.

An entitlement letter from the Jobcentre Plus Office would be appropriate evidence of exemption.

People Receiving Income-based Jobseeker's Allowance


Note there are two types of Jobseeker's Allowance (JSA), income based and contribution based. Only receipt of income based JSA entitles patients to free prescriptions.

JSA is paid by giro cheque or ACT two weeks in arrears so patients may not have evidence. A letter from the DSS/patient's local Job Centre Plus Office that states their entitlement would be appropriate evidence. The letter must confirm that the patient was entitled to free prescriptions on the date the patient completed the exemption declaration.

Universal Credit

As part of the government’s changes to the benefit system, Universal Credit is a new benefit being introduced in April 2013. Those receiving this benefit will be eligible for free prescriptions.

Universal Credit will be rolled out in only a few areas for the moment and as such the prescription form itself will not change for the time being. Patients who are able to produce a valid Universal Credit award letter bearing their name (either as the recipient or because they are a partner or child of the recipient), should sign to declare their exemption and will need to tick the box for “income-based Jobseeker’s Allowance”.

The areas where Universal Credit will be introduced in April 2013 are as follows:

  • Oldham
  • Tameside
  • Warrington
  • Wigan

As patients can get their prescriptions dispensed from any NHS community pharmacy in the country, pharmacies outside of these areas should also be aware.

A decision will be made by October 2013 concerning the roll-out of this benefit to other areas.

Further information can be found here:www.nhs.uk/uc-healthcosts and http://www.dwp.gov.uk/policy/welfare-reform/universal-credit/.

The Patient or his/her Partner is getting Pension Credit Guarantee Credit (PCGC)


A letter from the DSS/patient's local Job Centre Plus Office would be appropriate proof. The letter must confirm that the patient was entitled to free prescriptions on the date the patient completed the exemption declaration.

The Patient is a War Pensioner holding a War Pension Exemption Certificate and the Prescription is for the Accepted Disablement


Appropriate proof of exemption would be a war pension exemption certificate. Patients can apply for a war pension exemption certificate by writing to The Veterans Agency, Norcross, Blackpool FY5 3WP.Or telephoning 0800 169 2277.

Employment and Support Allowance (ESA)

 

The Department of Work and Pensions are introducing a new benefit, The Employment and Support Allowance (ESA) on 27 October 2008. The income-related strand of this new benefit will entitle a patient to free prescriptions.

 

Some contractors may already be aware that in preparation for this change, newer prescription forms (Version 0608) are gradually feeding into circulation. The form has been amended to combine the Income Support declaration line (on the reverse of the form) with Income Related ESA.

 

After the 27th October 2008, if the old version of the FP10 form is presented by someone entitled to claim exemption because they are in receipt of Income Related ESA they should tick the Income Support declaration box. The patient should be able to provide evidence in the form of a DWP award notice.

 

This notice will indicate if the patient is in receipt of Income Related or the Contribution based ESA benefit. Only patients receiving the income related strand of ESA will be entitled to free prescriptions.

 

 Prisoners on Release

 

The NHS Charges Regulations have been amended from 1 April 2008 to exempt all prison issued FP10 and FP10MDA prescriptions from the prescription charge arrangements where the letters ‘HMP' along with the issuing prison address and PCT allocated number have been printed in the practice address box on the front of the prescription (Note: the addition of a handwritten ‘HMP' is not acceptable. Some guidance has been issued suggesting that the letters HMP will be ‘stamped'. This is not correct, the letters must be printed, not applied as an additional stamp).

Patients presenting such prescriptions at a pharmacy will automatically be exempt and they are not required to sign to claim entitlement to exemption. All other legislation and good practice guidance continues to apply to these prescriptions including the good practice guidance that persons collecting a Schedule 2 or 3 Controlled Drug should sign the prescription to confirm receipt and the patient should print their name (and address, if different from the front of the form), in part 3 of the prescription form.

Should the patient be homeless then the use of "No Fixed Abode" is acceptable. The prescriptions should be submitted to the PPD in the ‘no-charge' group. Within this group the forms should be sorted as described on the FP34C submission document (i.e. by form type, prescriber type). Forms received from prisons do not need to be separately bundled. The NHSBSA Prescription Pricing Division has assured PSNC that PPD staff will be trained on this change to ensure that these prescriptions are not inappropriately ‘switched'. PSNC will be monitoring this closely.

Pharmacies may be contacted in advance of the patient presenting a prescription, so that the prescriber can be aware of the services (such as supervised administration) available from the pharmacy and to deal with any queries that might arise. Department of Health Guidance

Common Queries


Receiving incapacity benefit or the contribution based Jobseeker's allowance would not entitle a patient to exemption from prescription charges.

Asylum seekers have to pay for their prescriptions unless they are entitled to exemption from prescription charges. Asylum seekers who are supported by the National Asylum Support Service (NASS) are automatically sent an NHS Low Income Scheme HC2 certificate which entitles them to full help with help costs including free prescriptions. Alternatively patients can apply for support using the HC1 application form.

Following the introduction of the Civil Partnership Act, same sex-couples who have entered into a civil partnership agreement are entitled to state benefits as a couple and are therefore able to obtain help with health costs as a couple.

As EPS Release 2 rolls-out, PCTs will be providing pharmacies with dispensing tokens. The FP10DT0407 dispensing tokens were  produced in 2007 and whilst the reverse of the form was correct at that time, this version of the form does not include a reference to claiming exemption because the person gets the income related Employment and Support Allowance (ESA).The old version of the dispensing token will remain in circulation until the forms are used up. People who are included in an award of income-related Employment and Support Allowance and who need to complete an exemption declaration on the old version of the form should tick box H “*gets Income Support” to claim free prescriptions.  The new dispensing token which was developed in June 2008 (FP10DT0608) correctly references current exemption categories. 

Information on help with health costs is available in leaflet HC11 (TC) which is available by calling 0300 123 1002 or by posting, faxing or emailing the Order Form to the Department of Health.

More Information


A useful reference to support checking patients exemption status is the NHS Counter Fraud & Security Management Service guide to ‘Point of Dispensing Checks'. It contains detailed guidance on the NHS prescription charge exemption and remission categories, the type of evidence needed by a patient to claim exemption/remission from the prescription charge and the penalties for patients who evade NHS charges. The guide can be downloaded in full from the CFSMS Website.

Back to Prescription Charges


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