Prescription Charge Card and Free-of-charge (FOC) Items and Multi-Charge Factsheets
Published on: 14th March 2014 | Updated on: 11th May 2023
Prescription Charge Card
Following the Government decisions to increase in the NHS prescription charge the NHS prescription charge will be uplifted on 1 April 2023 to £9.65.
The cost of PPCs has also increased, with the price of a three-month PPC at £31.25 (an increase of £1.00) and a 12-month PPC at £111.60 (an increase of £3.50). PPCs offer savings for those needing four or more items in three months, or 12 or more items in a year.
The recently announced HRT PPC will cost £19.30 (the cost of two prescription charges). Please note that whilst the HRT PPC was originally announced as costing £18.70, this has increased to reflect the rise in the prescription charge. This PPC can only be used when a patient is prescribed a listed HRT medicine.
|Prescription charge type||Previous charge (up to 31st March 2023)||New charge (1st April 2023 onwards)||Increase of|
|Single charge (per prescription item)||£9.35||£9.65||£0.30|
|HRT PPC (valid for 12 months)||N/A||£19.30||N/A|
Community Pharmacy England’s Prescription Charge Card confirms the new NHS prescription charge of £9.65 per item, explaining that this is a tax from the Government that does not benefit the pharmacy who collects it in any way, and highlighting the cuts to pharmacy funding. Should this wording raise questions, pharmacy team members could use this as an opportunity to raise awareness of the #SaveOurPharmacies campaign and direct people to the campaign website: https://saveourpharmacies.co.uk/
Meanwhile, the Prescription Prepayment Certificate (PPC) Poster provides information on how much PPCs can save patients. It also describes the new HRT PPC alongside a QR code that can be scanned to access further information.
All versions have been designed to be easy to download and print ready for display in community pharmacies.
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. 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.
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.
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.
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.
Please note this resource is not exhaustive and is subject to change.
FAQs – ‘FS’ endorsed items
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).
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.
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.
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).
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.
A. All paper prescriptions with the prescriber ‘FS’ endorsement should be placed in a red separator when submitted to the NHSBSA for processing.
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.|
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.
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.
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
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.
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).
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.
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.|
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.
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.
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.
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)
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.
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.
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.
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.
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.
A. No. The HRT PPC will be valid for any product on the HRT medicines list, whatever the clinical reason for the prescription.
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”.
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.