Guest Post from Mr. Dispenser: The Back of It

Thank you, Mr. Dispenser for this great guest post! It’s about how prescriptions are paid for in England, geared towards the US audience. It’s quite enlightening and very interesting. I hope you guys enjoy it. If you get a minute, you should check out his blog. He’s a great writer that I always enjoy reading. My US counterpart can be found on his page.


The Back of It

In England, the majority of people get free prescriptions if they qualify through 13 categories. Although, I really wish patients would stop asking me what they should tick on the back of their prescription!



The categories are:

A] Under 16 years of age

It makes me chuckle when people tick income support on their babies’ prescription. The parents fill in the prescription but writes down her exemption instead of the child’s.

B] 16, 17, 18 AND in full time education

If you leave school at 16 and get a job, then you pay. Students start university at 18 years of age and get quite upset when they hit 19 and realise that they have to pay. I have seen students blatantly lie about their age even though it is printed on the prescription.

C] Over 60

The people who use the most medicines get free drugs too. The pharmacy staff sometimes fill out the back of the prescription for people who are exempt by age, when we receive the prescription from the doctors. Sometimes, they tick over 60 when they patient is not. One day, I will get a slap when handing out a prescription for an insecure 55 year old lady

There is no requirement for someone over 60 to sign the back of their prescription if it is a printed prescription as it’s obvious from the date of birth that they will be exempt. Depending on how grumpy the person is, I do or do not make them sign.

Sometimes you may ask someone to pay and they say that they are over 60 and it’s confirmed by looking at the prescription properly. If you apologise and say that they look good for their age, then you will get brownie points.

D Maternity exemption

Once you get pregnant and up to the child’s first birthday, your prescriptions are free. Sometimes, ladies will ask me if I want to see their exemption card but I say that I can see their evidence. This is either a big bump or a baby.

Sometimes, this is ticked by a man with medical exemption by accident which causes much hilarity and embarrassment for the man.


E] Medical Exemption

People with certain conditions get free prescriptions. These include epilepsy, diabetes and under active thyroid. Recently cancer was added to the list which is excellent. However, my Auntie was over the moon when she got diabetes as she now has free prescriptions for life.

F] Pre-payment certificate

If you do pay for your prescription, then it can get costly. Each item costs £7.65. If you need more than 4 items in 3 months or 14 items in 12 months, then a three or twelve month pre-payment is a good option. They cost £29.10 and £104 respectively. Then you can get as many prescriptions as you want.

Unfortunately, some people don’t believe that it is a good offer. I once wasted 5mins of my life explaining the benefits of a pre-payment complete with calculations and my working out and they couldn’t be bothered. I’m more upset about having to do some calculations.

G] War pension

Former soldiers are also entitled to free prescriptions.

L] HC2

People on low incomes can apply for a HC2 certificate. This is normally but not exclusively used by students once they turn 19. It normally depends on how much savings they have, whether they work and how much their parents earn.

X] Free of charge contraceptives  

All women get free contraceptives on prescription. Some women who have another non-contraceptive item on the prescription, sometimes conveniently forget to pay for that item and just tick X. These women get chased after by overweight pharmacists.

H] Income support

This is the most common benefit that is ticked on the back of the prescription. This is also the default option when people don’t know what to tick. Some people who can’t speak English just say ‘H’ when asked what they tick. It is also normally ticked by people in expensive cars who have just come back from holidaying abroad

K] Jobseekers allowance

This is another benefit that is given to some people. It is normally ticked by people in McDonalds uniform and taxi drivers


M] Tax credits

Another benefit that is generally claimed by people who work part-time or have a partner that does. Some pharmacy staff claim this. There is sometimes the awkward situation when they don’t want to accept any more hours at work as it will affect their tax credits.

S] pension credit guarantee credit

I have never seen anybody tick this option

Prescription Charge

The prescription charge is a contribution to the NHS. It is not a payment to the pharmacist. It bears no relationship to the cost of the medication. It is currently £7.65.The quantity of each item is irrelevant.

There are some anomalies. A pair of hosiery stockings carry two prescription charges. If you are prescribed the same drugs in different strengths is only one charge. A drug prescribed in two different formulations is two charges.

False exemptions

There is a great opportunity for patients to tick anything on the prescription. At the end of the month, all the prescriptions get sent off to The National Health Service Business Services Authority for payment. Less than 1% of the exemptions are checked by them. So it is highly likely that you will not get caught unfortunately.

There is an ‘evidence not ticked box’ on the back of the prescription for the pharmacy to tick if the patient has not provided any evidence. Pharmacy contractors are in no way responsible for the accuracy of a patient’s declaration; this remains the responsibility of the patient. Patients found to have wrongly claimed help from the NHS with the cost of their NHS prescriptions will face a penalty charge and in some cases prosecution.

If the patient does not tick anything on the back of their prescription and it gets sent off, then £7.65 is taken off the pharmacy. It is in the pharmacies best interest to ensure that the back of the prescription gets filled in.


Mr Dispenser

My blog can be found here