« Previous | Contents | Next »
Listen
ANNEX B
SUMMARY NOTE OF PRESCRIPTION CHARGE AND EXEMPTIONS POLICIES
1. Prescription charges were first introduced in 1952 for patients in the community and, except for a three-year period between 1965 and 1968, have been levied ever since. The flat rate prescription charge (currently £6.50) does not relate directly to the cost of the prescribed item or the cost to the NHS of supplying it, but is a contribution towards the cost of the service as a whole.
2. NHS prescription charge exemption arrangements are designed to protect those who are most likely to have difficulty paying charges. NHS National Services Scotland ( NSS) estimates that around 50% of the population qualifies for free prescriptions under the current exemption rules. However, because this group includes the elderly and children, both high 'users' of medicines, over 90% (68 million) of items dispensed in Scotland are supplied to the patient free of charge. Qualification for exemption or remission of charges fall into three main categories.
3. Medical grounds: The chronic medical conditions that confer exemption from charges were agreed with the medical profession in 1968 and are listed in the NHS (Charges for Drugs & Appliances) (Scotland) Regulations and are:
- Forms of hypoadrenalism (including Addison's disease) for which specific substitution therapy is essential;
- Diabetes insipidus or other forms of hypopituitarism;
- Diabetes mellitus (except where treatment is by diet alone);
- hypoparathyroidism;
- myasthenia gravis;
- myxodoema, or other conditions which require supplemental thyroid hormone;
- epilepsy requiring continuous anti-convulsive therapy;
- a permanent fistula, requiring an appliance or continuous surgical dressing;
- continuing physical disability which prevents the patient from leaving his/her residence without the help of another person.
4. The criteria for placing conditions on the list were that they must be easily recognisable, lifelong and life threatening. All require regular, prescribed medication. Representations are made regularly on behalf of patients who suffer from a wide range of chronic medical conditions that do not confer exempt status. Because of the number and diversity of cases made, Scottish Ministers have until now consistently considered that extending exemption to any one additional medical condition could not be justified.
5. Age: People aged 60 and over, pregnant women and nursing mothers, children under 16 and young people under 19 in full-time education are exempt from paying charges.
6. Financial status: Those receiving Income Support, Income-Based Job Seeker's Allowance, Working Family and Child Tax Credits and people who qualify for full help under the NHS Low Income Scheme are exempt. In addition, those who hold a valid exemption certificate because they receive a War or MOD Disablement Pension receive free prescriptions in respect of medication arising from their disablement. Non-exempt people who hold a valid prescription pre-payment certificate also receive free prescriptions and prescriptions for contraceptives (except condoms) do not attract a charge.
7. To put the cost of exemption into context, the cost of providing pharmaceutical services from community pharmacies and by dispensing doctors and appliance suppliers in Scotland in 2004-05 was £982 million (£859 million for drugs etc and £123 million for remuneration). For the same period, prescription charges, including the sale of pre-paid certificates, totalled £44.4 million, which is 4.5% of the cost of pharmaceutical services and around 1% of NHS Boards' total revenue budget.
8. The prescription charge has risen from £5.90 in 1999-00 by 10 pence increments each year to the current £6.50. Charges collected in 1999-00 totalled £42.9 million and rose to £46.3 million in 2002-03 but, as evident from above, has fallen back since then. This is probably due to changes in the tax credit arrangements that have resulted in more people being exempt on the grounds of financial status under the Low Income Scheme.
9. Pre-payment certificates remain a cost effective way of paying prescription charges if a patient needs more than 5 items in a four month period (charge - £33.90), or more than 14 items in a 12 month period (charge - £93.20).
« Previous | Contents | Next »