NHS Prescription Costs, Exemptions and Charges Explained (2026)
Prescription charges in England are one of the most asked-about NHS costs for expats. This guide covers exactly what you pay, who qualifies for free prescriptions, how Prepayment Certificates work, and how to manage medication costs as a new UK resident.
An Important Starting Point: England Only
Prescription charges only exist in England. In Scotland, Wales, and Northern Ireland, all NHS prescriptions are free for all residents regardless of age, income, or condition. If you are moving to Scotland, Wales, or Northern Ireland, you will not pay for NHS prescriptions at all — this section of the guide applies only to those settling in England.
This is one of the most practically significant differences between the four NHS systems, and one that surprises many new arrivals who assume NHS prescription policy is uniform across the UK. It is not. If you take regular medication, where in the UK you live has a direct financial impact.
The Current Prescription Charge in England
This is the charge per prescription item in England. If your GP prescribes three medications on one form, you pay £9.90 for each — £29.70 in total. The charge applies per item, not per visit or per form. Charges are reviewed annually, typically increasing each April.
The charge of £9.90 per item has been in place since April 2024, when it increased from £9.65. It is reviewed by the government each year as part of the NHS charging framework. For many people who take one or two items occasionally, the charge is straightforward. For those on multiple regular medications, the cumulative cost without an exemption or Prepayment Certificate can be significant.
Who Pays and Who Does Not
A substantial proportion of prescription items in England are dispensed free of charge because the recipient qualifies for an exemption. The NHS Business Services Authority estimates that around 90% of prescription items are dispensed without a charge being paid — either because the patient is exempt or because the medication is covered by a Prepayment Certificate.
| Group | Free prescriptions? |
|---|---|
| Under 16 | Yes — automatically exempt |
| 16–18, in full-time education | Yes — in England |
| Aged 60 or over | Yes — automatically exempt |
| Pregnant (with valid MedEx) | Yes — during pregnancy |
| Had a baby in last 12 months (with valid cert) | Yes |
| Medical Exemption Certificate (60+ conditions) | Yes — for all medications |
| Universal Credit, Income Support, Pension Credit | Yes |
| NHS Low Income Scheme (HC2 certificate) | Yes |
| War pension holders (for relevant conditions) | Yes |
| Scotland, Wales, Northern Ireland residents | Yes — all prescriptions free |
| Everyone else in England | No — £9.90 per item |
Exemptions Explained
Age-Based Exemptions
Children under 16 receive free prescriptions automatically — there is no application process required. Young people aged 16 to 18 who are in full-time education also receive free prescriptions in England; they complete an HC1 application form to confirm their eligibility. People aged 60 and over receive free prescriptions automatically without any application.
Maternity Exemption
Pregnant women and women who have given birth in the last 12 months are entitled to free prescriptions in England. To access this, you need a Maternity Exemption Certificate (MatEx). Your GP or midwife provides an FW8 form to apply; the certificate is issued by the NHS Business Services Authority and is valid from the start of the 11th week before your due date until 12 months after the due date. It covers all prescription items, not just pregnancy-related medications.
Medical Exemption Certificate
A Medical Exemption Certificate (MedEx) entitles you to free prescriptions for all your medications — including those unrelated to the qualifying condition. Over 60 specified conditions qualify, including:
- Diabetes mellitus (except where treated by diet alone)
- Epilepsy requiring continuous anticonvulsive therapy
- Hypothyroidism (underactive thyroid)
- Addison's disease and other forms of hypoadrenalism
- Hypoparathyroidism
- Myasthenia gravis
- Myxoedema
- Diabetes insipidus and other forms of hypopituitarism
- Permanent fistula requiring continuous surgical dressing
- Cancer requiring current treatment with chemotherapy or radiotherapy
To apply, ask your GP to complete a FP92A form. The certificate is issued for five years, after which it can be renewed. If you have a qualifying condition and are currently paying for prescriptions, speak to your GP as soon as possible — you may be entitled to claim back charges paid in the previous 12 months.
Important: A Medical Exemption Certificate covers all your prescription items — not just those for the qualifying condition. If you have diabetes and also take medication for high blood pressure, both items are free with a valid MedEx.
Benefits-Based Exemptions
People receiving certain means-tested benefits are entitled to free prescriptions in England. The qualifying benefits include Universal Credit (with certain income conditions), Income Support, Income-related Employment and Support Allowance (ESA), Income-based Jobseeker's Allowance (JSA), Pension Credit (Guarantee Credit), and NHS Low Income Scheme assistance (HC2 certificate). If you are claiming any of these benefits, check your eligibility with your benefits adviser or GP surgery.
Prepayment Certificates: The Most Useful Tool for Regular Medication
If you pay for NHS prescriptions in England and take more than one or two prescription items regularly, a Prescription Prepayment Certificate (PPC) is almost certainly worth buying. It allows you to pay a fixed fee and collect unlimited prescription items for the covered period.
| PPC type | Cost | Break-even point |
|---|---|---|
| 3-month PPC | £31.25 | Worth buying if you collect 4+ items in 3 months |
| Annual PPC | £111.60 | Worth buying if you collect 12+ items per year |
At £9.90 per item, 12 items per year without a PPC would cost £118.80 — more than the annual PPC of £111.60. If you take two medications monthly, that is 24 items per year, which would cost £237.60 without a PPC. With the annual PPC at £111.60, the saving is over £125 per year.
PPCs can be purchased online at nhsbsa.nhs.uk, by phone through the NHS Business Services Authority, or by completing an FP95 form at your GP surgery or pharmacy. You can pay in monthly instalments by Direct Debit. The PPC does not require a GP referral or medical assessment — anyone who pays for NHS prescriptions in England can buy one.
How to Claim Your Exemption at the Pharmacy
When you collect an NHS prescription at a pharmacy, you will be given a form (the back of the prescription) asking whether you are exempt from charges and on what basis. You tick the appropriate box — for example, "I am under 16," "I have a Medical Exemption Certificate," or "I have a Prepayment Certificate." You sign the declaration to confirm your entitlement.
The NHS carries out regular checks and can request evidence of exemption. Making a false declaration to avoid paying a prescription charge when you are not entitled to exemption results in a penalty charge — currently £100 plus the original charge. If you are unsure whether you qualify for an exemption, ask your GP surgery or pharmacist before signing a declaration.
NHS Low Income Scheme
If you do not qualify for automatic exemption but your income is low, you may be eligible for help with prescription costs (and other NHS charges) through the NHS Low Income Scheme. Completing an HC1 form — available from GP surgeries, pharmacies, and Jobcentre Plus offices — will result in either full or partial assistance being granted via an HC2 or HC3 certificate. This scheme is open to UK residents regardless of immigration status, though the assessment is based on your current income and savings.
Expats and Prescription Charges
Paying the Immigration Health Surcharge does not exempt you from NHS prescription charges in England. The IHS grants you access to NHS services — the same access as a UK resident — but standard patient charges, including the prescription charge, still apply unless you qualify for an exemption on the same grounds as any other England resident.
If you take regular medication, the practical approach is to: register with a GP promptly on arrival, ask your GP whether any of your conditions qualifies for a Medical Exemption Certificate, and consider purchasing an annual PPC if you take multiple items regularly. For expats moving to Scotland, Wales, or Northern Ireland, none of this applies — prescriptions are free regardless.
Related guide
What else does the NHS cover for free? Our guide to free healthcare in the UK covers everything from GP visits to hospital treatment, maternity care, and dental charges.
Dental and Optical Charges
NHS dental and optical charges are separate from prescription charges and work on different rules. NHS dental treatment in England is structured in three bands: Band 1 covers examination and cleaning at £26.80; Band 2 covers fillings, extractions, and root canal treatment at £73.50; Band 3 covers more complex work including crowns, dentures, and bridges at £284.30. Once you begin a course of NHS dental treatment, you pay the band that covers the most complex treatment in that course, regardless of how many individual treatments are involved.
NHS eye tests are available free for children under 16, people aged 60 or over, those with diabetes or glaucoma risk, and those on qualifying benefits. Most adults pay approximately £25 to £35 for an NHS sight test. Optical vouchers help with the cost of glasses for children and some eligible adults following an NHS sight test.
For most expats living in England and taking regular medication, the prescription charge is a manageable cost that becomes very manageable with a Prepayment Certificate. The key actions are simple: check whether you qualify for an automatic exemption, apply for a Medical Exemption Certificate if you have a qualifying condition, and buy an annual PPC if you take more than around 11 items per year. For those in Scotland, Wales, or Northern Ireland, prescriptions are simply free — no action required beyond registering with a GP.
Prescription charges are not the largest financial consideration when moving to the UK, but they are a recurring one, and knowing the system prevents unnecessary expense. The NHS offers a genuinely comprehensive exemption framework — it is worth a few minutes with your GP to make sure you are not paying charges you are entitled to avoid.
For a broader picture of NHS costs and what is covered, read our guides on what the NHS covers for free, how to register with a GP, and NHS eligibility as an expat.
Frequently Asked Questions
This article is for general information purposes only. NHS prescription charges, exemption criteria, and PPC costs are reviewed periodically and may change. Always verify current charges and your eligibility at nhsbsa.nhs.uk or with your GP surgery.
- England: £9.90 per item (from April 2026)
- PPC (Prepayment Certificate): £111.60/year — unlimited items
- Scotland, Wales, N. Ireland: FREE for all
- Free if: under 16, over 60, pregnant, qualifying conditions
- NHS Low Income Scheme (HC1): apply for help with costs
- Dental Band 1 £26.80 / Band 2 £73.50 / Band 3 £284.30
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