Why are some prescriptions free and others aren’t?

[Soubriquet]

Before I start, I just wanted to say I do not hate those who get free prescriptions but I do wonder how the nhs can charge between them

Diabetic medicine is covered. Yet inhalers for asthmatics aren’t?

Both are life saving medication but the nhs only covers one

So how do they decide that?

And for those who have to pay, please don’t forget you can get a pre pay certificate which helps pay for your prescriptions every month instead of having to pay for each one

we get free prescriptions in Jersey but have to pay for the doctors to issue the prescriptions and also to see a doctor. Its £3-5 per prescription and £40 per docs visit.

Tried to work out with my sister which system was better as she is in the uk, and we couldn't come to a conclusion!

@ivykaty44

marioduck Hyperthyroidism is dangerous and can cause coma & death left in medicated but you don’t get free prescription

I don't dispute that there are plenty of conditions not on the list that are also serious, my point is merely that hypothyroidism is not some minor inconsequential illness.

@ilovebagpuss a prepayment certificate would probably save you money - it's a flat rate for 3 or 12 months regardless of how many items you get.

www.nhsbsa.nhs.uk/help-nhs-prescription-costs/prescription-prepayment-certificates-ppcs#:~:text=Exemption%20certificates%20Prescription%20Prepayment%20Certificates%20%28PPCs%29%20A%20PPC,prescription%20charges%2C%20a%20PPC%20could%20save%20you%20money.

Stupid broken link

www.nhsbsa.nhs.uk/help-nhs-prescription-costs/prescription-prepayment-certificates-ppcs

I'm both asthmatic and diabetic so not biased with my answer. My asthmatic prescription is an inhaler every few months, my diabetic prescription is ridiculous.... insulin (2 types), testing strips, needles, lancets. I can go through a pack of testing strips in less than a week sometimes. So I ve always wondered if its the cost but then I guess I'd buy a certificate so there would be a cap on it.

But what a pp said about it being a loss of a function makes sense.

It is unfair that diabetics get unrelated prescriptions free. But yes it could be based on the cost of not controlling diabetes, its a disease that is easy to bury your head in your sand bcos on a daily basis it doesn't matter if your blood sugar is a bit high, but it would cost the NHS a hell of a lot more if I lost my eye sight etc.

My son is type 1 diabetic. His prescription list for that one condition is very long. If he had to pay per item, a typical month is 7 separate items in various quantities. Plus there are all the out of prescription expenses that diabetics have...some pay £160 a month for a sensor if they cannot get it on the NHS. Liquid glucose treatments are over £1 each, glucose tablets £3.50 a tub of 50 which would last about 15 doses. It’s expected to have 3 hypos a week which need glucose treatment, and most require more than one dose to treat. My son has to have a mobile phone to operate his (NHS) sensor and in order to store the insulin calculator apps. I had to buy him a new phone with insurance in the end, as second hand ones kept dying and he relies on it. People with pumps often operate them from a phone…so essentially these are classed as medical devices but all costs are borne by the patient. People who have pumps also have to insure them themselves.
Kids get DLA but adults don’t, so they need to meet these costs with no assistance. So although diabetics might get free prescriptions…there’s a lot they still pay for which is essential to their treatment.

@NotMyCat me too! I get a years worth every 3 months without any issue so far with the agreement of my GP.

And then you have people like me that have a maternity exemption cert (I will need dentistry after baby has arrived so I'm afraid I grasped it with both hands for that purpose) that mean I could be getting my aspirin on prescription instead of paying 50p a month for it with the food shopping as I am doing. I have prescription indigestion medicine which I was happy to pay for but didn't get chance as pharmacist automatically did it on exemption as I was visibly pregnant. It's all very strange but it's been interesting to read the history that other posters have shared.

But FWIW I think asthmatics should get their inhalers for free.

My mum had type 1 diabetes from being a child and so she got free prescriptions and she was always grateful to the NHS.

I think the problem is the pisstakers; those that are constantly on their GP's back for prescriptions for infant paracetamol, ibuprofen, hayfever tablets and immodium because they get it free rather than paying a quid or so at the supermarket. I also know someone who gets a certain prescription drug free and then sells it to friends. And yes, I judge them.

I think the reason that successive governments have ignored it is because of the conditions that people would consider should be on the list.

Asthmatics are one obvious one, but the one that really baffles me that it’s never been added is transplant patients.

Spend all that money on operations and hospital care - then just hope they can afford their anti-rejection medications.

That's so awful prescriptions are free in Wales, Scotland and Northern Ireland.

I’m in a much better place now but years ago when I was a single parent I so say earned to much for free prescriptions. By the time I paid my child care and received tax credits I had £5 a week more than when I claimed income support. Every winter I ended up in a&e on nebulisers with just a cold as I couldn’t afford my daily brown preventer inhaler never mind the blue inhaler on top. Now I feel so lucky to not have to think about things like that. Yet breathing is what keeps us alive.

@WreckTangled - he uses the Libre. Diabetic nurse wouldn't prescribe it though because, ironically, his diabetes is too well controlled. If his control was bad, they'd prescribe it, but because his HBA1C has been good for years (he hasn't been under a consultant for at least 10 years), it's a case of 'computer says no'.

As someone said upthread, the conditions that get free medication are those where long term drug treatment was available when the list was set up. Diabetes, hypothyroidism and epilepsy were all treatable whereas things like asthma inhalers only came along later so are not included
Around 9 in 10 prescriptions in England are exempt from charges and, ironically, those that pay are more likely to get cheap medication like antibiotics or painkillers. Having seen the amount people waste and the lack of respect for cost I would, personally, make everyone pay a nominal charge per item which would save the NHS a fortune but that will never happen

Although the pre-payment certificates should be a valuable safety net to stop you having to pay a fortune, they're still likely to hurt those who would benefit from the the very most, if they commit you to paying a £10 or so DD every month, when you're already struggling. To a person with a reasonable income, it's a source of comfort to have all your prescriptions sorted for that single small-ish monthly payment, but to somebody having to count every penny, it can be a source of fear.

If you know you don't really have that tenner to spare, then if you don't buy it, you can avoid getting your prescription for as long as possible, or maybe (ill-advisedly) eke out two months' supply to last for three. Of course, you will have to pay in the end - and will probably be in a worse financial position and in worse health as a direct result; but I think there are parallels with that brilliant Terry Pratchett illustration about rich and poor people buying boots.

Moreover, whilst it's the best solution there currently is to the problem, the very existence of the PPC is effectively an official admission that those in the worst health are being failed. If it were widely referred to as 'the asthma tax' (or whatever other long-term serious condition) - and this usage could gain significant ground in the media - it would be shown up for the exploitative scheme that so many people find it to be, all the while being told that they should be immensely grateful for it.

Isn't that basically what happened for cancer sufferers - where campaigns eventually shamed the government into giving them free prescriptions?

That's so awful shock prescriptions are free in Wales, Scotland and Northern Ireland.

And in 90% of cases in England - including many people who (or whose parents) could easily afford to pay, whilst many of the 10% who do have to pay struggle immensely to afford it.

I'm Asthmatic and although I don't get free medication, my GP has said before that if I couldn't pay for asthma meds they would cover them.
This was many years ago and the particular medication was nebulising salbutamol solution, she gave me a box and said they couldn't refuse because they were critical. Breathing is quite a necessity!
I think the only reason an asthmatics medication isn't free is down to numbers. Too many people need inhalers.

@ReviewingTheSituation he should pull out the NICE guidelines as that's not a reason for refusal. My hba1c is 5.6% so not being in poor control is definitely not a reason to be given one. (It's one of the criteria but you don't have to meet all of them, pretty sure it's just type one diabetic who finger pricks >8 times a day when not using a FGM). Sorry he has rubbish care.

I’ll ask the pharmacist next time I’m there then @MilkTwoSugarsThanks. I wasn’t in the best place mentally when I was given the certificate.

Ds has severe asthma. Obviously as a child his medication is thankfully free but he has been on a cocktail of different drugs for the past 10 years so I can’t see that changing.

He has now been diagnosed with an adrenal insufficiency - related to the asthma - but my understanding is that will mean he now qualifies for free prescriptions when he is older.

I would be interested to see the balance of cost between what is made from prescrption charges and the cost of actually administrating it all

I have paid a pre paid certificate for prescriptions my whole adult life (apart from when I was a student).
I think they are good value for money, although I hadn't realised some conditions give you free prescriptions.

As I have 4 things (2 inhalers, 2 tablets) every day.

The certificate costs £9 per month so worth it if you have any regular prescriptions.

Thank you to those suggesting the pre payment certificate. I did work it out with the pharmacist one day and I’m just the other side of it being beneficial.

Flipping bonkers. I have hypothyroidism so get every prescription free. Husband has asthma and has to pay for his.
If I didn’t have my meds for a week, I’d be fine but dh wouldn’t be. The whole system is ridiculous.
Asthma can take your life in seconds.

If you were out and about (as an asthmatic), and needed an inhaler suddenly but you didn't have yours on you, could you go into a pharmacy and request one then and there without a prescription? I was musing this the other day and wondered, as obviously it can life saving.