Help with Prescription Costs

posted: 01/12/2008

Who has the right to help with prescription costs?

Greater Manchester HIV clinics will now only prescribe HIV treatment drugs and drugs for managing any side effects. This leaves medicines for anything else (depression, sexual dysfunction, contraception etc.) to GPs to prescribe, and that means some people have to pay for those GP prescriptions.

Many people are entitled to free prescrriptions; some can get free prescriptions because of low income, and there is a discount scheme to cut your costs. 

Other help with healthcare costs is available, including for travel expenses to and from hospital.

Citizens Advice Bureau has clear infomation here on all the help that is available for healthcare costs.

For prescriptions, some people can get them free, some people can get a full exemption on grounds of low income, and some people can get a discount by buying a prepayment certificate.

Free Prescriptions

You are entitled to get prescriptions free of charge if you:

• are over 60
• are on Income Support, income-based Jobseeker’s Allowance, income-related Employment and Support Allowance or the guarantee credit part of Pension Credit. Your partner and children will also be entitled to free prescriptions. (If you are getting Working Tax Credit and/or Child Tax Credit, you may be entitled to free prescriptions, depending on your income - see below - Help with health costs if you are on a low income)
• have a listed medical condition (HIV is NOT listed, see page 30 here for full list) and have a valid medical exemption certificate. You have to ask your GP if you think this might apply to you - ask for Form FP92A
• have a continuing physical disability which means you cannot go out without help from another person and have a valid medical exemption certificate - ask the doctor, hospital or pharmacist for Form FP92A
• are under 16 in England or Scotland. You must show age proof to the pharmacist
• get a war or service disablement pension, need prescriptions for your war / service disability and hold an exemption certificate - ask the doctor, hospital or pharmacist for Form FP92A
• are a prisoner
• are pregnant, or have had a baby in the last twelve months and have a valid exemption certificate. This includes if you have had a miscarriage after the 24th week of pregnancy, or your baby was stillborn. Ask the doctor, midwife or health visitor for Form FW8.
• you live in Wales

To claim, just tick the box on the back of the prescription form.

They do random checks afterwards to check that people who ticked the box were eligible. There is a penalty charge and possible prosecution for people caught claiming when not eligible.

In England, for full details of people who can get help with prescription charges, see the Department of Health leaflet HC11 Help with health costs.

If none of the categories mentioned in this list applies to you, you may still be able to get free prescription on the grounds of low income – see next section: Prescriptions for low income

 

Prescriptions for low income

If you have difficulty in meeting your health costs and do not qualify for any other kind of help, you may be able to get help under the NHS low income scheme.

The amount of help you get will depend on the amount of income you have. You might not be entitled to any help at all if you have too much in savings / capital. There are two types of certificate: a full help certificate (HC2), and a limited help certificate (HC3), which tells you how much you have to pay.

Full help certificate

If you are entitled to a full help certificate, you will get:-

• free NHS prescriptions
• free NHS dental treatment, including check-ups
• free NHS sight tests (including sight tests at home) and full value vouchers for glasses or contact lenses
• full repayment of necessary travel costs for hospital treatment
• full repayment of travel costs if travelling abroad for treatment
• free NHS wigs and fabric supports
• travel costs if travelling abroad for treatment.

Limited health certificate

If you are entitled to a limited help certificate, you will get no help with prescription charges (but see Prepayment Certificates for prescriptions below) but may be able to get some help with the costs of:-

• dental treatment and check ups
• private sight tests
• vouchers for glasses or contact lenses
• wigs and fabric supports
• necessary travel costs to and from hospital for NHS treatment
• travel costs if travelling abroad for treatment.

How to apply for help on the low income scheme

To apply for either a full help certificate (HC2) or a limited help certificate (HC3), complete form HC1, which is available from local benefit offices, NHS hospitals, dentists, opticians and pharmacists. Form HC1 can also be filled in online.

Do not wait until you need a prescription or treatment before you apply for a certificate. Getting a refund after you have paid is better avoided. You would need to ask the pharmacist for a special receipt when you get your prescription, which you then have to use to reclaim the money. If you don't get the special receipt when you hand in the prescription, you can't claim a refund.

Remember, if you don't qualify now because your income is too high, if your income drops you can always make a fresh claim.

Send the completed form HC1 to

NHS Business Services Authority
PO Box 370
Newcastle Upon Tyne
NE99 2ZA
0845 850 1166
website

 

Prepayment Certificates for prescriptions

If you need frequent prescriptions but do not qualify to get them free of charge, you can buy a prepayment certificate which could save you money.

Prepayment certificates save you money if you have to pay for more than three prescription items in a three-month period, or more than 14 items in a twelve month period. Remember each drug prescribed counts as a seperate item, so two drugs on one prescription counts as two items.

In England prepayment certificates last for either three or twelve months. You can pay for the twelve month certificate by direct debit, in ten equal monthly instalments.

Before buying a prepayment certificate, make sure you are not entitled to free prescriptions, as it can be difficult to get a refund once you have paid for your certificate.

You can buy a prepayment certificate:

• over the phone from the NHS Business Services Authority 0845 850 0030
• online from the NHS PPA website
• from the pharmacist
• from your Primary Care Trust

You are sent a plastic card (like bank card) that you show to the pharmacist each time you hand in your prescriptions and tick the box on the back of the prescription to say you have a Prepayment Certificate.

Health Care Help

Help with health care costs can be for:

• prescription charges
• NHS dental charges, including check-ups
• sight tests
• vouchers towards the cost of glasses and contact lenses
• travel costs to and from hospital for NHS treatment
• travel costs if travelling abroad for treatment
• wigs and fabric supports, for example, abdominal and spinal supports, and support tights.

Details of all the NHS health care help available.

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