Prescriptions: to charge or not to charge?

Prescriptions: to charge or not to charge?

The Prescription Charging Coalition, of which NRAS is a member, will soon be publishing a report on the impact of charging for prescriptions. The report will highlight a number of issues, but in order to support the statistics it provides and give the story a personal touch, it always helps to have some case studies. These cases studies will help demonstrate how the issues have a very real impact on people’s lives.

If you have been affected by prescription charges, perhaps to the extent that you’ve had to go without your prescription in order to provide another basic need, then we would really like to hear from you.

This is an issue that is extremely important to us so if you are willing to share your story then please get in touch. My email address is andrew@nras.org.uk and I will be more than happy to discuss it further with you.

62 Replies

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  • Have to get a prepayment as would be too expensive otherwise

  • How did you find out about the prepayment card? Lack of awareness about its existence was another issue that came up in the report.

  • When I was under 60 I found the prepayment worked very well as if you bought your prescriptions carfeully you can get 4 months supply instead of 3 !

  • hmm I Work when well enough in pharmacy.. click on my profile pic and all will be revealed

  • That would certainly give you a good awareness of them.

  • I don't currently pay as I have an HC2 exemption but have really struggled in the past even affording the prepayment card. I take 5 different meds every day plus another 4 which I take at varying times during the month so have 9 different prescriptions every month. What annoys me is that my sister, who has hypothyroidism, is totally exempt from charges regardless of what the meds are for - so, if she needs antibiotics for something, she still doesn't have to pay even though it's not for her exempt condition and that really doesn't seem fair. Our meds are essential for us to leave as normal a life as possible. Without my steroids and prescription strength painkillers in particular, I wouldn't be able to function. I just wonder if there's a fairer way of exempting prescriptions - such as exempting the particular drug and not the person.

  • Hiya! Do you think you could drop me an email so we could have a quick chat as I think you have picked up on quite a major issue - some are exempt and some aren't, and this creates an unfairness to the system. Thanks!

  • I think things like paracetamol (&other minor drugs) should not be on prescription when you can buy 48 in the pound shop for a £. GP's should be encouraged to tell patients this - but we are so steeped in thinking a pill from the doctor is better - we have to educate the patients as well as the doctors.I'm sure we all know the patient who "stocks up" on pills and that all adds to the cost of the NHS.If I were under 60 I would be paying out £50 a month for necessary drugs which I certainly couldn't afford.

  • I'm a nurse so I always advise my patient of any exemptions they may be entitled too. An important part of my job.

    Carole

  • That's very encouraging to hear and I'm sure many of your colleagues do likewise.

  • I live in Scotland where prescriptions are now free to all since the SNP got in. I have to say it would be a vote winner for me but I'm exempt anyway and I think I would still be exempt in England too as I take Levothyroxine? My husband and I are self employed and he's a care worker so we are low income and we couldn't afford to live in England now - what with prescriptions and university fees. Not having to pay for our drugs improves the quality of life here a great deal and makes us feel less stigmatised for the drugs we need to take. Tilda x

  • My contribution seems to have disappeared. Anyway, another Scottish contribution - the free prescription is fantastic. I assume its cheaper to administer than any other system too. Only suggestion is that you need a NICE for any system like this to stop the drug companies making a fast buck out of the NHS.

    And a further thought - how long before the patents expire on the anti=tnf and they can be made cheaper? That's a date to look forward to for everyone.

  • I'm sure that some people would argue the drug companies are still making a quick buck despite what NICE do, but that's another issue :)

  • I left Scotland before the SNP came to power so never had the benefit of free prescriptions, but it was certainly a very popular move. The fact that Scotland and Wales have free prescriptions makes the situation in England seem even more unfair. That said I'm sure there are some benefits to the system down south that aren't available up north.

  • As a recent migrant north, quite honestly I cant think of many!

    Our local chemist is brilliant too and they have this system where you get your prescription delivered to your nearest chemist to pick up (unless you want it delivered). Come back, Andrew!

  • Yes but don't come back until NRAS has a Scottish branch please! I think there are probably all sorts of worrying things going on behind the scenes Cathie, from Scottish hospitals trying to massage their waiting lists and find bogus reasons to chase people of anti-tnf drugs, to staff shortages and a very beleagured Scottish rheumatology service. I heard on the Radio Scotland news recently that cancer patients requiring ongoing checks and treatment, some extremely urgent, are being made to wait for many months so that the Scottish NHS can get through their early diagnosis lists and then leave patients stranded. This wouldn't be legal in England but somehow the Scottish NHS has managed to allow this to happen in many of the hospitals up here. So it may all seem to be relative roses but I believe that's for reasons of political expediency in some areas.

  • I'm sure you're right, but news from Lewisham and Cornwall suggest that the rot has gone much further at least in some areas.

  • Name one benefit that we in UK get that is not available in Scotland... I can't find any. I wonder if Scotland does leave the UK after their referendum, how long their free presciptions & free university education will survive?

  • Im on relatively low income as I am only well enough to work part time as Watson said nurses, drs, pharmacy staff etc should make patients aware of prepayment. diabetes, hypothyroidism and epilepsy are exempt I get three month one stock up on painkillers etc not hoard you understand! I use it to my advangage I Have had so far about £64.00 pounds of nhs scripts using a 3 month £ ca 30 Pre payment card.

  • Well done summer that is exactly how I used the prepayment - before I entered my dotage that is!!! But bet your bottom dollar they are working on stopping that being possible!

  • My GP told me about the prepayment card at the beginning of my illness - am very grateful to him. There have been times when I have found it hard to find the money for it, and ended up renewing it in Boots because I could use my credit card to pay for it, and then pay it back later. If I didn't have it I am sure I would end up skimping on things like painkillers in order to save on prescription costs. My GP is also very good about making sure that I have anything possible on prescription rather than bought over the counter eg Vit D/calcium.

    The unfairness bugs me too. My mtx/hydroxy combination is just as vital to keeping me well and contributing to the economy as thyroxine and insulin are to people who need to take them. Yet I have to pay. I don't understand the logic, and indeed I think there probably isn't any. I suspect its a historical quirk which needs to be ironed out. Preferably in favour of RA patients rather than by taking free prescriptions away from others.

  • It sounds like you have a very helpful GP which is good to hear. You are right in that the system does appear unfair - different long term conditions that all require medication should not be treated so differently when it comes to paying for treatment. That is something featured in the report and hopefully something that will be addressed.

  • I'd be interested to know whether free prescriptions for all would be cheaper to administrate than a selective system. I agree with you Dotty7! Otherwise maybe certain chronic conditions give you access to free prescriptions. I'd rather they were free across the board!

  • I imagine there would be less administration with the Scottish system but whether that alone would be enough to justify no prescription charges I'm not so sure. If people aren't taking their required medication though, perhaps because they cannot afford them, then the ultimate cost here would presumably make free prescriptions worthwhile.

  • Earlier in the week there was mention that Scottish GPs were under prescribing for people with long term conditions in Scotland and because of this Administration costs were soaring because of the need for regular repeat prescriptions.

  • I'm not excusing it but the reason insulin and thyroxin are both regarded as exceptions is because they aren't drugs but are chemicals the body is supposed to create itself naturally and without them people die so there's not really a choice element. I believe it's a historic exemption because once they have been started the body stops making them naturally.I don't understand why this entitles people to all medication for free though. It's not because being Hypothyroid is more serious than having RA.

    As someone who takes both, as many people on this site do with the autoimmunity connection, I agree wholeheartedly that without our RA meds life would be grimmer and I also agree of the economic benefits to making them free. The paperwork alone to create all these exemptions and prepayments etc must be ridiculous? But then Cathie is also right to point out that the pharmacutical companies have a lot to answer for and the cost to the Scottish NHS must be pretty ridiculous too so there has to be a middle way but I'm not a politician or a policy maker.

    A locum GP once said to me "I'm pretty well off - so why do I get my prescriptions for free? It's daft if you ask me!" when printing off a prescription for me (this was the start of my RA and I hadn't had a prescription made out in this way for five years or so at that stage so didn't realise they were free to everyone!) but to be honest there's so much form filling to be done in life - especially if you have children - that not having to think about paying for or filling forms in for drugs is a huge relief. Tilda x

  • That's quite interesting to hear why there is the variation between the different conditions and whether or not you pay for medication. Thanks for sharing that.

  • I purchase a yearly prepayment certificate, I was advised to do this by the pharmacist when I first started taking MTX, and have continued to purchase this even when I changed to ant-tnf as it works out cheaper than individual items bought. I am keeping my fingers crossed that nothing changes between now and September when I reach my 60 birthday as I shall then fall into the non-payment area through age.

  • That's great that your pharmacist was able to advise you and I would hope that many others would do the same although I'm sure that is not he case with everyone. I don't think it is a case of trying to hide it, I suspect it is more a case of just not thinking to mention it.

  • I only heard about the prepayment card when i first got diagnosed, I was told by a lady that served me at my local chemist, Being i haven't been able to work in the last 7 months i have only been receiving SSP, which is still not enough to have to pay out for the prepayment cards, Now that my SSP, is coming to the end, i am now going to find it even more difficult to find the cash, There will only be my husband working and we also have a daughter to support,

    why can't people that are getting SSP for long term sick, be entitled to free prescription until they are able to return to work?

    Shirley

  • Prepayment cards weren't something I was aware of until relatively recently. The report highlights that there should be more of a campaign to raise awareness of the cards (and the exemptions where applicable).

    With having to pay for your prescriptions, can you see there being a time when you would have to make a choice of paying for your prescription or providing some other basic need. Certainly when people are already under pressure through not being able to work, having to then pay out more money for medication is perhaps an expenditure too much.

  • I just cannot believe how many people don't seem aware of the pre-payment prescription system. It has been available for so many years now - I think I used it back in the early 1990's when I was first diagnosed with RA and was chopping & changing medications regularly before I found something that worked. Surely there should be a note on the back of all presciptions ar at least in GP's surgeries & in places like Boots?

  • I'm going now, but couldnt resist poking my nose in one last time. Your locum GP who can afford the prescription may have a point, but the universal principle means that everyone has a stake in the public service. The really wealthy probably go to private doctors with expensive private prescriptions anyway. But I do believe very firmly that there's a big advantage in making these things universally available so everyone benefits.

    I'll keep quiet now!

  • You have made some absolutely valid points so thank you. Maybe I should move back up north again :)

  • I wouldnt be anywhere else. Friends in Cornwall are having a dreadful time, they seem to be closing down all funding for CABs and resource centres. Where will it end? I'm really off now!

  • I used to live in Cornwall during the bad old 80s and it always was one of the hardest hit places when push comes to shove re poverty and neglect. I always wondered if this was because the focus has always been on the north/south divide politically so I think it is the forgotten county of the south, apart from for surfing and nice holidays.

    All this said, you are living in central belt Scotland and the Scottish Capital Cathie, and I'm sure things are as bad as they are in Cornwall in the outlying regions of Scotland - especially ones which aren't SNP strongholds and don't have our oil reserves. Free prescriptions are great I agree, and if they prove to be financially more viable than all the bureaucracy and paper work that goes on with the English pre-payment system then hopefully this fundamentally fairer Scottish system will survive up here - but I wouldn't count on it remaining this way.

  • I sometimes get a Private Prescription and you'd be surprised now inexpensive some pills are - trouble is the Doctor's fee is huge if you don't have medical insurance. I always asked the pharmacist how much the drug was and if it was less than the scrip charge if I could buy it without a scrip.

  • Hi All, feeling in delicate hibernation mode following recent round of GP/hospital appointments so licking wounds and regrouping before joining in blogs again :( Just wanted to add, for those that are not aware, that you can apply for a prepayment cert online and there's a monthly DD option that makes it much easier to budget for. A godsend as I used to find it hard to find a lump sum before and, as to how I'd manage without, it doesn't bear thinking about! I have twelve meds on my repeat. Admittedly four of them aren't used every day but if I had to pay per item I'd be in prescription poverty as the bill would rival my fuel bill and I'm only able to work two days a week at the moment. Thanks for trying to fight our corner Andrew x

  • Thanks Andrew it's good to have this discussion. Mind you, speaking of fuel poverty - ours up here is currently the highest in the UK and my husband worked out that here we have the most expensive petrol/ diesel in the World - apart from Italy! So if the SNP ever renege on free prescriptions for all we will be completely done for in my household. Scary stuff.

  • my doctor as told me i cant work due to arthritis of the spine and gaps in the vertebrae i was not to happy about it but after being in hospital a few times i agree with him the money is not that good but health is more important but dwp don't seem to agree i have been for my 14 week health check and they have told me i am fit for work but my doctor does not agree he said he will not sign me off the sick but dwp said i must work as anyone got any ideas

  • Hi Andrew

    I have arthritis, non cf bronchiectasis (from babyhood), asthma, ibs and oesteoporosis (apart from that I'm alright ;-). I brought my daughter up alone from her being 6. I did have a small amount of maintenance which meant I had to pay for prescriptions.

    Pre-payment is obviously less expensive if you have above a certain amount of drugs per month, BUT they are not cheap. I could never afford to be able to pay out for a year and always had to purchase the (I think it was 4 months originally and then changed to 3 but don't quote me on that). I have occasionally been in a situation where I have discussed with the pharmacist and not purchased one of the drugs. There have been other occasions where the pharmasist has informed me that a drug prescribed which can be bought over the counter would cost less.

    I am a pensioner now and it is one less worry that I can have my medication. Well at least for the timebeing - with this government with their massive shears out it wouldn't surprise me what is next in line for a cut.

    Love C

  • hi i live in Kent i have a prepayment card because i simply can't afford the cost of prescriptions. i now take four! My GP will only prescribe one month at time. My partner was the one who said to me to get prepayment as he has one too.Its so unfair if i had thyroid like a friend i would get all my prescription free. If the state wants you to work even if you feel unwell in pain and rotten the least they could do is give your meds free.

  • I too used to get 3 monthly prescriptions for drugs that I have taken for years and as you say it was suddenly brought down to every month. I was recently told that this is not for medical reasons, but because under their new contract (at the time) it was agreed GP's would be paid PER PRESCRIPTION - hence 12 x £? rather thah 4 x £?.

    I don't know if this is true, but also don't know how to find out what is the truth. But I am sure fed up with having to go to the surgery every month just to pick up a scrip that never changes !!!

  • tell me about it drives me mad. its just another job i have to do! which i have to fit into my day. I'm told to pace myself

  • 11Years ago I was diagnosed with Acute Myeloid Leukanemia I was amazed when I was told there was no help to pay for all the medication I needed & remember telling my GP I could not afford the bill every week. There was no resolution I just struggled to find the money. A year later I was diagnosed with a Thyroid Problem. So my prescriptions are now paid for but now I have RA & other medical conditions. Not being able to work. I am waiting a tribunal date considering that. My financial posistion is not good. If i had to pay I couldn't afford to with all the medication I'm on. So many people are struggling it is such a worry.

  • Hi dancingqueen - isn't there a box you can tick on the prescription that says you don't have to pay if you cannot work or are on benefits? But if you have a thyroid problem that needs medication I believe you will then get free prescriptions. Good Luck any way....Kathy

  • It would be interesting to do some research on how many people cannot afford the prescriptions they are given and what impact this has on their long term morbidity. I'm sort of thinking about research done at the Nuffield in Oxford on the broad impact of anti-tnf treatment. I dont know the details of what they found except that it was possible to reduce the need for surgical interventions - because people with RA didnt need joint replacement any more

  • Hi Cathie..........It would help of course if the pre-payment certificates were better publicised to help those who cannot meet the cost of their prescription drugs.I think any change in prescription accessibility should be posted everywhere from the internet to the pharmacy. I was told by an orthopaedic surgeon that since DMARDs his work on RA joints has decreased markedly as the joints are preserved for much longer and surgery is now not automatically needed - thank goodness that is the case now......Kathy.

  • Absolutely!

  • Should make you aware any one receiving treatment for cancer has been eligible for free prescriptions since 2008 and so they should be I think we should have free ones too! the number of patients who say that to me! all I can say is that I pay the same as you and advise of prepayment or HC2 for people on v low income indeed!.

    When working in retail pharmacy I would always tell people if cheaper of prescription. Some people even my retired mum buy the odd medication themselves dispersible aspirin(75mg) 100 only cost abput £1 supermarket own paracetamol and ibuprofen cost pence again less than £1 you could say there is merit in people buying their own? but these cost NHS virtually nothing too.

    Most drugs much more than the £7.65 charge and wales and scotland both get theirs free of charge! cheaper exceptions are some eye drops, some anti biotics( these are script only private script for amoxicilin can cost as little as £3 ! , inhalers.

  • ntinuing above comment some inhalers salbutamol /ventolil standard inhalers cost Nhs £6 BUT like anti biotics in this country are prescription only.

    An enbrel pre filled syringe costs nhs £90 and I would love some! a simponi pen cost and c£765,00 cimza costs £360.00

  • Kathiefitz12 Ithink you have misunderstood me. I do now get my prescriptions free but worry that I will once again have to pay for them If this goverment has its way. There is such an attack on people like me who are to ill to work. & disabled. The Panorama programme shown last week really showed what people dealing with us think & its frightening, I really feel like a burden to society at the moment. I'm waiting to take my case to a tribunal with trepidation. Thanks for your thoughts anyway.

  • I understand why people say exemptions should only include the drug itself, eg, anti-convulsants for epilepsy. But we knowthat illnesses have other effects and also side effects of strong drugs for the condition which people may have to take medication for. So I am not sure that is the way to go. I am exempt myself, but have to take other medication because of side effects of the drug that helps me intially. Perhaps the NHS should look at just having a nominal charge of a medication instead. Easy to manage and a lot cheaper probably!

  • I think £7.65 is a nominal charge for very many drugs.

  • correct see my above comments

  • Not when you have 12 items - not including antibiotics it isn't. I am a pensioner now, but for many years I had to pay and even though I am exempt (for the moment anyway) does not mean I don't feel it unjust so many sick have to pay a tax for the priviledge.

    XXX

  • Strange too they always announce increase in prescription charges before the budget!!!!!!

  • Hi,

    I had a PPC card for years, bought online and paid for by monthly DD so that worked out I think at about £100 pa. (The pharmacy sold me my first card.)

    I am now over 60, so assuming the government don't move the goalposts, my scripts are free.

    I have just looked through my prescription, and I have 16 items. If they were given out monthly that would be about 200 prescription items p.a. (I have RA, Sjogrens, Asthma and Hypertension.)

    So that would cost me above £1500? Scary!

    A while ago I asked my GP to give me 3 months worth of each item if that would be ok, and he was happy to do that. ( which in theory reduces my bill to about £500 p.a.)

    I think it should be part of a Pharmacists responsibility to point out the PPC card system as soon as they come across a patient with more than a couple of long term prescription items on their list.

    On the subject of those who qualify for free prescriptions (Diabetes, Cancer, etc) my view is that if your disease without medicine will kill you, the Medicine must obviously be free of charge.

    If you have a disease that probably won't kill you (eg RA, PA, AS, MS, etc) but the Medication possibly might do, or might give you other problems to treat too, then you have to pay.

    I remember on my Diagnosis day 20 years ago, my GP said to me:

    "The worst thing about RA is that it won't kill you." I still don't know if this was a joke or not!!

  • Hi Phoebe - You were lucky your GP would give you 3 months supply of meds .My GP told me that under "The Rules" (whose rules I ask) she was only allowed to prescribe 2 months supply.

    I think patients should have access to "The Rules" - as it is we are sitting ducks who are told wahtever the GP feels like telling us ..Kathy

  • My GP and local pharmacy r great at telling you the cheapest option. If the doc prescribes nothing that u can buy cheaper over the counter they told me. The chemist also told me of the prepayment scheme and how to apply for free prescriptions the day. Had to start medication for diabetes, so I was lucky I guess.

  • Many thanks to all of you for your responses. The issue of prescription charging is clearly a very emotive subject and it is great to hear your views on it. The Prescription Charges Coalition is due to publish its report on the 11th March and I will post a link to it here. In the meantime, for those who aren’t aware of the Prescription Prepayment Certificate, here is the link to the NHS page explaining a bit more about it: nhsbsa.nhs.uk/1127.aspx

  • Like everything being discussed in the present economic climate, surely those with incomes above a certain level should have to pay the prescriiption charge as they could afford it, but those on very little should at least only pay say 50% of the full charge.

    I keep being told means testing is expensive, but if you pay income tax - HMRC know this, know how much you earn and where you live....so they know where to find you to collect !

    Surely there is a computer programme that could screen in/out who should or shouldnd't pay.

    for prescriptions.

    There is a way that those people who say they do have a PPC but in fact don't have one can be located - so why not the same with prescription charge exemption.?

    Could it be because the powers that be just don't think it's vote catcher or maybe in fact they just can't think outside the box?

    Whatever the answer - someone earning the miniumum wage should not have to pay the same charge for a prescription as someone on £75K pa!

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