Prescription charges and people with long-term conditions

Date: Fri 5th May 2017

The Background

  • Prescription charges have risen almost every year since 1979, and currently stand at £8.60 per item, as of 1st April 2017.
  • Prescription charges were abolished for everyone in Wales in 2007, in Northern Ireland in 2010 and in Scotland in 2011. Audit Scotland1 and Welsh Assembly2 research shows that this has not led to an unusual increase in the use of prescriptions.
  • The NHS spends £9.3bn on pharmaceuticals in primary care each year3. £500 million is thought to be wasted due to the ineffective use of medicines4. For example this could be people skipping a dose, making their other medication less effective. There is a wealth of research, including international studies, which shows that cost has a key impact on medicines-taking behaviour and this therefore needs to be addressed as part of the Government's medicines optimisation strategy.
  • Five to eight per cent of hospital admissions are related to ineffective or inappropriate use of medicine5.
  • In its report on NHS Charges published in July 2006, the Health Select Committee considered the system of charges to be “a mess" and medical exemption criteria to be “confusing" and “outdated".

About The Prescription Charges Coalition (PCC)

The PCC is an alliance of over 40 organisations concerned with the detrimental impact of prescription charges on people of working age with long-term conditions. Following a survey, to which over 2400 people in England responded, the Paying the Price report was published in March 2013. It was followed, in March 2014, by a survey exploring the impact of prescription charges on the working lives of people with long-term conditions. Over 5,000 emails have been sent to MPs and more than 20,000 people have signed an e-petition on the issue, which is consistently listed as one of the most significant burdens for people living with one or more long-term conditions.

  1. Audit Scotland - Prescribing in General Practice in Scotland, Jan 2013
  2. Welsh Assembly Government - Helping To Improve Wales's Health: Free Prescriptions Three Years On, March 2010
  3. Prescription Cost Analysis England 2015
  4. Concordance, adherence and compliance in medicine taking.Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D (NCCSDO),December 2005
  5. Concordance, adherence and compliance in medicine taking.Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D (NCCSDO),December 2005,

What we are calling for: A clear commitment to review and reform the medical exemption criteria for prescription charges, which was compiled in 1968 and will be 50 years old next year, to include all those with long-term conditions.

Case Study

Zoe Oakley is 35, has two children and works part-time.

I have high blood pressure due to an inherited kidney disease. The consequences of this is that my kidneys don't control my blood pressure so it often gets too high resulting in nausea, heart palpitations, and headaches; it's like I can feel heartbeat in my head.

I've been on a concoction of tablets since I was 17 years old. My medication won't cure me, but it does help prevent strokes, and prolongs my kidney function for longer. If I don't take my medication, I start reacting negatively within a few hours.

I've had trouble affording my prescriptions - if I was running low I have had to wait until I got paid before getting my new batch of medicine. Sometimes this meant I had to skip certain pills to make them last longer. This has resulted in me being hospitalised twice, with brain scans and other tests to check there was no long term damage.

I really believe the life-saving drugs I rely on should be free, as they are for people with some other long term conditions.

The Issues

1. Prescription charges are a barrier to accessing medicines for many people of working age who have long-term conditions in England.

The PCC research found that costs were by far the biggest factor that prevented people from taking their medication as it had been prescribed. Pharmacists also report people asking them which of their prescriptions they can do without. Research from the PCC shows that one third of those with long-term conditions, who are paying for each prescription item, are rationing their medication due to the cost. Many respondents reported missing doses, cutting tablets in half and substituting cheaper but less effective over-the-counter alternatives to “eke" medicine out until pay day. Of the 36% who reported not taking their medicine as prescribed due to the cost, three quarters felt their health had got worse as a result and 10% said they had ended up in hospital. Not being able to afford prescriptions can lead to emergency hospitalisation, which may result in a cost that is greater than the revenue raised.

2. There has been no assessment of the consequences of prescription charges for people with long-term conditions.

People with long-term conditions, of working age, are disproportionately affected by prescription charges as they need regular and on-going medication, often over their lifetime. Many fall just above the threshold for low income exemptions, as they try to work in spite of their condition. The prescription prepayment certificate is felt to be unaffordable by a significant proportion, and is not effective for those with fluctuating conditions. As highlighted in the Health Select Committee Report into NHS Charges in July 2006, and in response to parliamentary questions and debates since, “There is a woeful absence of evidence about the effects of charges in this country. It is known that harmful effects occur but they are largely unquantified." Where people take their medicine correctly, they often report having to cut back on essential household costs, such as food, rent, utility bills or petrol to get to work. The stress of making these choices is likely to impact on an individual's condition and health outcomes, and their ability to stay in work.

3. Medical exemption criteria, set in 1968 and largely unchanged since, are outdated and illogical.

Many conditions that people now live with for years either didn't exist when the exemption criteria was created, or had such a short life expectancy it was not thought necessary to add them. On top of this, there are many elements that just don't make sense. For example people with cystic fibrosis are not exempt, unless they develop cystic fibrosis-related diabetes. There is a clear and pressing need for a review of the criteria and for this to be extended to all those living with long- term conditions in England. Many people suffer with more than one long-term condition. It is currently possible to have all of the conditions represented by the PCC and still have to pay prescription charges.

Unpublished survey data 2017

We are currently running a survey to find out about the impact of prescription charges in 2017. The survey has been completed by just over 2300 people so far. Early results show the following:

  • Almost 30% of people still pay for each prescription item individually.
  • 157 people said they could not afford the pre-payment certificate and a further 20% said they were not sure if it was worth it.
  • 243 people paid over £100 a month for medication.
  • 33% said they had not collected a prescription due to cost
  • 24% said they had sometimes missed pills or taken a lower dose due to cost.
  • 38% of these people (203) said the reason they had not taken their medication as prescribed was due to cost.
  • Nearly 40% said not having to pay for their prescriptions would definitely make a difference in taking their medication as prescribed and a further 31% said not paying might make a difference.
  • 55% (287 people) of people who had skipped medication said that their health got worse. • 47% (145) whose health got worse said they took time off work.

Conclusion

  • It is our view that exempting people with long term conditions from prescription charges would:
  • Improve individual quality of life and health outcomes.
  • Reduce health service costs, including unplanned hospital admissions arising from people
  • not taking their medicines as prescribed due to the cost.
  • Reduce health inequalities.
  • Better enable people with long-term conditions to maximise educational and employment
  • opportunities, support themselves and their families and contribute as fully as possible to society.
  • Aid medicine optimisation.

For further information, contact co-chairs of the coalition.