Would a prescription prepayment certificate save me money?
A season ticket for prescriptions in England. The arithmetic is simple, and there is a large group of people who should not be paying at all.
- Difficulty
- beginner
- Time
- 10 min
- Read
- 3 min
Short answer
In England, a prepayment certificate covers unlimited prescriptions for three or twelve months for a fixed price. Divide the certificate price by the single-item charge: if you get more items than that in the period, it saves money. Before buying one, check the exemption list — several million people are entitled to free prescriptions and pay anyway. There are no charges at all in Scotland, Wales and Northern Ireland.
This is the clearest arithmetic in NHS admin and it is still widely missed, mostly because people do not know the certificate exists. The twelve-month certificate can also be paid by direct debit in instalments, which removes the up-front barrier that puts people off.
Step by step
- Check whether you should be paying at all.Exemptions in England include being under sixteen, sixteen to eighteen and in full-time education, sixty or over, pregnant or having had a baby in the previous twelve months with a maternity exemption certificate, holding a medical exemption certificate for one of a specified list of conditions, or receiving certain benefits. The NHS Business Services Authority publishes the current list.
- Apply for a medical exemption certificate if you qualify.It covers a defined list of long-term conditions, is applied for through your GP practice, and lasts five years. It is not automatic — many eligible people have never applied.
- Count your items, not your prescriptions.The charge is per item dispensed, not per prescription form. Someone on four regular medicines is paying four charges each time.
- Do the arithmetic.Divide the three-month certificate price by the single-item charge, and the same for the twelve-month one. If you receive more than that number of items in the period, the certificate saves money. Both figures are on the NHS Business Services Authority site and change most Aprils.
- Buy the right length.Three months suits a defined course of treatment. Twelve months suits ongoing medication, is proportionally cheaper, and can be paid in monthly direct debit instalments.
- Buy it before you need it, or claim back.A certificate can be backdated by a short period, and prescriptions paid for in that window can be refunded if you kept the receipt — ask for form FP57 at the pharmacy at the time of paying, because it cannot be issued afterwards.
- Check whether an HRT-specific certificate applies.England has a separate, cheaper prepayment certificate covering HRT items specifically, which is better value than the general certificate for anyone whose only regular items are HRT.
- Diarise the expiry.It does not renew automatically unless you are paying by direct debit for a twelve-month certificate. An expired certificate leaves you paying full price without noticing.
- Get help with costs if you are on a low income.The NHS Low Income Scheme provides full or partial help with prescription, dental, optical and travel costs for people who are not otherwise exempt. It is applied for on form HC1 and is widely under-claimed.
Questions people ask
Do I pay for prescriptions in Scotland or Wales?
No. Prescriptions are free at the point of dispensing in Scotland, Wales and Northern Ireland. Charges and prepayment certificates apply in England only.
How many items make a certificate worth it?
Divide the certificate price by the single-item charge. Both are published by the NHS Business Services Authority and change most Aprils, so use the current figures rather than a remembered rule of thumb.
Can I claim back what I have already paid?
Only within a short backdating window, and only if you asked for an FP57 refund receipt at the pharmacy at the time you paid. It cannot be issued later.