Prescription Charge Card and Free-of-charge (FOC) Items and Multi-Charge Factsheets

Published on: 14th March 2014 | Updated on: 3rd May 2024

Please note we revised our Prescription Charge Card on 2nd May. The new version can be downloaded below.

Prescription Charge Card

The NHS prescription charge was uplifted to £9.90 from 1st May 2024.

The cost of a three-month PPC will become £32.05, whilst a 12-month PPC is increasing to £114.50. PPCs offer savings for those needing any four or more prescription items in three months, or 12 or more items in a year.

The newer HRT PPC will also increase to £19.80 (the cost of two prescription charges). This PPC can only be used when a patient is prescribed a listed HRT medicine.

In summary:

Prescription charge type Previous charge (up to 30th April 2024) New charge (1st May 2024 onwards)
Single charge (per prescription item) £9.65 £9.90
HRT PPC (valid for 12 months) £19.30 £19.80
3-month PPC £31.25 £32.05
12-month PPC £111.60 £114.50

Community Pharmacy England’s Prescription Charge Card confirms the new NHS prescription charge of £9.90 per item.

Meanwhile, the Prescription Prepayment Certificate (PPC) Poster provides information on how much PPCs can save patients. It also describes the HRT PPC alongside a QR code that can be scanned to access further information.

Posters

Prescription Charge Card 2024/25 (colour)

Prescription Charge Card 2024/25 (black and white)

PPC Poster 2024/25 (colour)

PPC Poster 2024/25 (black and white)

All versions have been designed to be easy to download and print ready for display in community pharmacies.


FAQs

Q. Do I need to display a notice about the NHS prescription charge?

A. Yes, it is part of the NHS Terms of Service to have an up to date notice about the NHS prescription charge displayed in the prescription reception area. For further information, please see the clinical governance premises approved particulars.

Q. If a prescription was dispensed before the 1st May but the patient does not collect items until after the 1st May, should the patient pay the old or the new prescription charge rate?

A. There is no national guidance on this issue so pharmacy staff will be required to exercise their professional judgement. Whatever decision is taken, pharmacy staff are advised to keep a record of the amount charged and the reasons for doing so on the PMR.

Q. For EPS, how do the NHSBSA determine which prescription charge rate to apply if a paid prescription dispensed in April is submitted for payment in May?

Any paid electronic prescriptions dispensed in April 2024 with an NHS prescription charge levied at the old charge rate (£9.65) will have a charge deduction of £9.65 applied by the NHSBSA if the Dispense Notification (DN) message is submitted before 30 April 2024 and the corresponding Claim Notification or Electronic Reimbursement Endorsement Message (EREM) is received by the NHSBSA by the end of 5 May 2024. Please see below how paid electronic prescriptions are treated by the NHSBSA following a change to the prescription charge rate.

  • If a DN is submitted on 30 April and EREM is received by NHSBSA by 5 May – this would be treated as April dispensing (£9.65 deducted for chargeable scripts)
  • If a DN is submitted on 1 May and EREM is received by NHSBSA by 5 May – this would be treated as May dispensing (£9.90 deducted for chargeable scripts)
  • If a DN is submitted on 30 April and EREM is received by NHSBSA on or after 6 May – this would be treated as April dispensing (£9.90 deducted for chargeable scripts). There would be no checking of the dispense date in this instance as the claim message was submitted would be outside of the first five days of the following month (EPS 5-day window).

Free-of-charge (FOC) Items and Multi-Charge Factsheet

Community Pharmacy England produces it’s Free-of-charge (FOC) Items and Multi-Charge factsheets as quick reference guides that can be used as guidance or on the counter. The Multi-charges factsheet helps to identify items that incur more than one prescription charge and lists some of the commonly encountered multiple charge items. This factsheet also provides information on charges for compression hosiery and lymphoedema garments. The Free-of-charge (FOC) Items factsheet explains what items are classed as free-of-charge (FOC) and lists contraceptive drugs to be dispensed free-of-charge.

Factsheet: Multi-charge items

Please note this resource is not exhaustive and is subject to change.

Factsheet: Free-of-charge (FOC) Items


FAQs – ‘FS’ endorsed items

Q. What does the prescriber endorsement ‘FS’ stand for?

A. The prescriber endorsement ‘FS’ (free supply) has been introduced to enable prescribers to indicate to pharmacy staff that the prescribed product can be provided to the patient free-of-charge (FOC).

Q. Why was the 'FS' endorsement introduced?

A. Existing legislation under the NHS Act 2006 provides for free-of-charge treatment for sexually transmitted diseases (STDs). The ‘FS’ prescriber endorsement was introduced in January 2020, and was developed as a technical solution to allow free supply of items used for the treatment of a sexually transmitted infection (STI).
The Department of Health and Social Care (DHSC) announced in March 2022 that it was extending the use of the ‘FS’ endorsement to enable free supply of certain COVID-19 trial medicines to patients participating in either the HEAL-COVID or the STIMULATE-ICP clinical trial platforms. This extended use is expected to remain in place until 31 March 2023. The DHSC took the decision to exceptionally use the ‘FS’ endorsement for this purpose as it is already available to prescribing systems and meets the requirements for this particular service.

Q. Is there a list of drugs to which the ‘FS’ prescriber endorsement can be applied to?

A. The ‘FS’ endorsement will operate by way of guidance; prescribers should exercise their clinical discretion in accordance with their professional duties and obligations.

For sexually transmitted diseases (STDs)

There is no specific list of drugs to which the ‘FS’ prescriber endorsements can be applied to. It is considered that only those conditions for which sexual contact is a main route of transmission of an infection should be ordinarily managed as “STI treatment”, for example, treatment for chlamydia would be FOC whereas treatment for candidiasis would not. Guidance on STIs that may be suitable for managing in primary care can be found in the guidelines section of the BASHH website and in the standards for the management of sexually transmitted infections.

Free supply of certain COVID-19 trial medicines

There is no specific list of drugs to which the ‘FS’ prescriber endorsements can be applied to. The trial medicines are usually supplied directly to eligible participants by the clinical trial team. However, because some participants in these trials will be required to take the drugs for up to 12 months and the treatments are being used outside their normal licensed indications, the Medicines and Healthcare products Regulatory Agency (MHRA) have advised that GPs should prescribe the trial medicines to patients using an FP10 prescription form or the Electronic Prescription Service (EPS). The trial medicines used in HEAL-COVID are Apixaban and Atorvastatin. STIMULATE-ICP currently uses Famotidine and Loratadine (in combination), Rivaroxaban and Colchicine. 

Q. Where a prescriber has endorsed ‘FS’ against an item on a prescription, does the patient need to make a declaration and sign the reverse of the FP10 form or Token?

A. As with other FOC items, such as contraceptives, there is no patient tick box on the new versions of the paper FP10 form and Token. This is because legislation does not require a patient, or their representative, to make a declaration or sign a form where the prescriber has endorsed ‘FS’. Patients are not required to provide evidence of entitlement for ‘FS’ endorsed items. In EPS, the message code ‘Y’ (0017) should be used for prescriptions containing only ‘FS’ endorsed items. The message code ‘Y’ (0017) should be populated before an EPS claim is submitted for payment (some PMR systems may automatically apply this code if an ‘FS’ endorsed item is prescribed). 

Q. In EPS, can ‘FS’ endorsement be added to the dosage instructions to ensure it is treated as a free-of-charge item?

A. The ‘FS’ endorsement should NOT be manually added to the EPS dosage instructions field as this would not allow a pharmacy contractor to supply any item(s) FOC against NHS prescriptions. Addition of any free-typed supplementary information to the dosage instruction field or other fields such as ‘additional instructions’, will not be taken into account for reimbursement purposes as this information is not captured by the NHSBSA during processing. If an electronic prescription is received with the prescriber ‘FS’ endorsement contained within the dosage area, the prescriber should be contacted to cancel the prescription, and a correctly endorsed prescription re-issued. See cpe.org.uk/dosearea. 

Q. How do I submit paper prescriptions with items endorsed ‘FS’ at the end of the month?

A. All paper prescriptions with the prescriber ‘FS’ endorsement should be placed in a red separator when submitted to the NHSBSA for processing.

Q. What does a patient pay for a prescription that has both a FOC ‘FS’ endorsed item and other items on it?

A. Ideally, prescribers should not include items classed as FOC (for e.g. ‘FS’ endorsed item) on the same prescription form as a chargeable item. Where such prescriptions are received, the table below highlights whether a patient would pay a prescription charge using different examples of ‘FS’ endorsed prescriptions:

Patient status Prescription for
‘FS’ item only ‘FS’ item + other FOC items (contraceptives) ‘FS’ item + chargeable item
Exempt from prescription charges No charge No charge If a patient has a valid exemption from prescription charges, the actual reason for exemption should be selected. The item endorsed ‘FS’ will be automatically treated as an FOC item.
Pays for prescriptions No charge No charge Patient pays for the chargeable items only. Any ‘FS’ endorsed STI treatments are automatically treated as FOC and no prescription charges should be levied for these.

Q. How will the NHSBSA process prescriptions with ‘FS’ endorsed items?

A. The NHSBSA will recognise the ‘FS’ endorsement when it is correctly applied by the prescriber and treat the marked items as free-of-charge, accordingly.

In EPS, prescribers should confirm ‘FS’ by selecting the appropriate flag, so that the prescription carries the ‘FS’ endorsement correctly. The ‘FS’ endorsement must not be manually added by a prescriber to the free text field EPS dosage area or other free text sections of the prescription as this will not be recognised by the NHSBSA during processing. To ensure that ‘FS’-endorsed medicines are treated as FOC items by the NHSBSA, pharmacy teams must ensure the correct exemption reason is selected before the prescription is submitted for payment

On paper FP10’s, prescribers must endorse the front of the paper prescription form by writing ‘FS’ and signing next to each item. Paper prescriptions with items endorsed ‘FS’ should be placed in the red separator for exempt prescriptions when submitted to the NHSBSA for processing. 

Q. Are all items on the prescription exempt from prescription charges if a prescriber has added ‘FS’ endorsement to an item?

A. No, only those items endorsed ‘FS’ should be treated as FOC. All other items would be chargeable unless the patient is exempt from prescription charges for other reasons.

Q. Can the pharmacy manually endorse ‘FS’ on a prescription

A. No, only prescribers can apply the ‘FS’ endorsement. Without the ‘FS’ endorsement, the prescribed treatment would be treated as a chargeable item, and patients would be advised that unless they are exempt from charges for another reason, they will have to pay the appropriate charge.


FAQs – free-of-charge contraceptives

Q. Will the EPS message code ‘X’ (0010) for “was prescribed free-of-charge contraceptives” continue to remain available for selection in EPS?

A. The EPS message code ‘X’ (0010) for “was prescribed free-of-charge contraceptives” will remain on EPS systems that usually display it. This message code remains on EPS systems because population of a message code field is mandatory before an EPS claim is submitted for payment to the NHSBSA. However, the category ‘X’ for “was prescribed free-of-charge contraceptives” has been removed from the reverse of the new version of FP10 forms and Tokens.

Q. Do contractors need to submit dispensing Tokens for electronic prescriptions where only FOC items are prescribed?

A. There is no longer a requirement to include any Tokens with FOC items only (e.g. contraceptives) along with other Tokens normally submitted to the NHSBSA at the end of the month. If, however, the prescription contains other items for which a charge should normally be levied, the prescription should be processed as either charge paid, or the appropriate exemption category should be selected (and where required, any corresponding Tokens should be submitted to the NHSBSA).

Q. Should FOC items and chargeable items be prescribed on the same prescription?

A. Ideally, prescribers should not include items classed as FOC on the same prescription form as a chargeable item. DHSC guidance states that “free-of-charge items should not be included on the same prescription form as items for which a charge is usually applicable”. NHSBSA’s “Requirements and Guidance for Endorsement in the EPS” also states “prescribing systems should assist prescribers by splitting items onto separate prescriptions where a combination of [FOC such as contraceptives] and other chargeable medication items are prescribed at the same time”. Where prescribing systems have not been updated, it may be technically possible for pharmacy teams to receive prescriptions with both FOC items (e.g. contraceptives) and chargeable items despite this guidance.

Q. What does a patient pay for a prescription that has both a contraceptive and another item on it?

A. Ideally, prescribers should not include items classed as FOC (for e.g. contraceptives) on the same prescription form as a chargeable item. Where such prescriptions are received, the table below highlights whether a patient would pay a prescription charge using different examples of contraceptive-containing prescriptions:

Patient status Prescription for
Contraceptive only (FOC) Contraceptive + other FOC items (such as an ‘FS’ endorsed item) Contraceptive + chargeable item
Exempt from prescription charges No charge No charge If a patient has a valid exemption from prescription charges, the actual reason for exemption should be selected. The contraceptive will be automatically treated as an FOC item.
Pays for prescriptions No charge No charge Patient pays for the chargeable items only. Any contraceptives are automatically treated as FOC and no prescription charges should be levied for these.

Q. How does NHSBSA process prescriptions for contraceptives?

A. The Drug Tariff (Part IXA and Part XVI) lists FOC contraceptive items which do not require a prescriber endorsement. Items prescribed for contraceptive purposes but not listed in the Drug Tariff need to be annotated by the prescriber with initials ‘CC’ or the female symbol (♀) so that a charge is not levied for any items so marked. The NHSBSA automatically identify the FOC contraceptives listed in the Drug Tariff and those marked for contraceptive purposes accordingly, to ensure no prescription charges are deducted regardless of paid/exempt status declared by the patient.

Q. I received an EPS prescription for a contraceptive and inadvertently marked it as charge ‘paid’ when submitting the EPS claim message. Will a prescription charge be deducted by the NHSBSA during pricing?

A. Contraceptive drugs and appliances listed in the Drug Tariff (Parts IXA and Part XVI) and items endorsed ‘CC’ are automatically treated as FOC by the NHSBSA regardless of a patient’s exemption or charge status. So, if an EPS prescription for a contraceptive listed in the Drug Tariff (or item endorsed ‘CC’) is inadvertently marked as ‘paid’, no prescription charge will be deducted by the NHSBSA for these FOC items.

Q. Are there any reimbursement risks associated with processing of EPS prescriptions which include FOC items such as contraceptives and other chargeable items?

A. Yes, there may be a risk of an incorrect number of prescription charge deductions being made against such prescriptions based on the category selection made via the EPS submission for entitlement to free prescriptions. For example, if an EPS prescription includes a FOC contraceptive and another chargeable item, and the prescription is submitted with the “was prescribed free-of-charge contraceptives” message code ‘X’ (0010) applied to the EPS message, a charge deduction will apply to the chargeable item even if the patient was exempt from prescription charges for other reasons, for e.g. medical exemption. An EPS prescription of this type should have been submitted with actual exemption reason which is applied at a form level rather than the item-level, “was prescribed free-of-charge contraceptives” reason for entitlement to free prescriptions.

Q. Can my PMR system support the processing of EPS prescriptions which have a contraceptive and a chargeable item prescribed on it?

A. Some PMR systems may auto-populate the required EPS message code in the appropriate way to simplify pharmacy processes. PMR systems may also provide support to minimise the risk of pharmacy staff making incorrect category or EPS message code selection errors which may result in inappropriate charge deductions (for e.g. by preventing selection of the ‘contraceptive’ status to the whole prescription if other chargeable items are ordered on the same prescription). If your PMR provider does not offer such safeguards, you may choose to speak to your PMR supplier to see if they can support further improvements to reduce reimbursement risks around inappropriate EPS message code selection. Read more about making suggestions and feeding back to your PMR supplier at: cpe.org.uk/reportIT.

FAQs – HRT prepayment certificate (HRT PPC) 

Q. Where can I find the most up to date list of HRT medicines covered by the HRT PPC?

A. The list of HRT medicines covered by the HRT PPC will be published in Part XVI of the NHS Drug Tariff from April 2023. The up-to-date HRT medicines list will also be available on the HRT PPC application page and the NHSBSA help with health costs page.

Q. Where can patients purchase an HRT PPC from??

A. The quickest way for patients to buy an HRT PPC is online at www.nhsbsa.nhs.uk/hrt-ppc. It is optional for pharmacies to sell PPCs. Community Pharmacy England recommends that patients visit the NHSBSA website to identify and purchase the PPC that is most suited for their needs.

Q. Am I required to ask patients for evidence of their HRT PPC if they declare exemption from paying prescription charges for HRT medicines for this reason?

A. Any time a patient makes a declaration that they are exempt from paying an NHS prescription charge, pharmacy staff must ask them to sign a declaration and produce evidence. Pharmacies must advise the person claiming exemption from prescription charges, where evidence is required but not provided, that the NHS undertakes checks to verify that such persons are eligible for free prescriptions. This is a legislative requirement of terms of service The National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 under paragraph 7.

Q. Is the HRT PPC refundable?

A. The HRT PPC certificate is non-refundable, so patients must check this type of certificate is suitable for them before they purchase it. Patients can call 0300 330 2089 for help and support.

Q. Can a patient purchase an HRT PPC if they are prescribed a listed HRT medicine for an indication other than for the treatment of menopause?

A. HRT may be prescribed for indications other than the symptoms of menopause. The HRT PPC is valid for any listed HRT medicines, regardless of the patient’s clinical indication or gender.

Q. Am I required to check that the patient is using a listed HRT medicine for the treatment of menopause?

A. No. The HRT PPC will be valid for any product on the HRT medicines list, whatever the clinical reason for the prescription.

Q. What changes have been made to paper FP10s and tokens?

A. To support the introduction of the HRT PPC, FP10 forms and EPS tokens have been updated to include a new exemption category ‘W’ for “HRT only prescription prepayment certificate”.

Q. Where can I obtain the updated dispensing tokens from?

A. Once older versions of dispensing tokens have been used up, pharmacy teams should obtain updated dispensing tokens directly from Primary Care Support England (PCSE) via the pharmacy stationery online ordering portal.


Related resources

Exemptions from the prescription charge

What does the patient pay?

Prescription charge refund procedure

Prescription prepayment certificates (PPCs) – guide to selling PPCs

HRT Prescription Prepayment Certificates (PPCs)

 

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