Where does the money from NHS prescriptions go?
Posted by JuniperScents@reddit | AskUK | View on Reddit | 70 comments
Does the money from prescriptions help fund the national health service or go to the pharmacists or anything else? I have not actually paid since I was diagnosed diabetic in my twenties , but I do realise in that time I have kept an awful lot of my own money due to being exempt.
True_Peanut_8092@reddit
It's a flat rate that goes towards paying for all prescribed drugs. So my asthma drugs are only actually around £1 I think, but some other drugs are more (or a lot more) than the £9.60. So the cheap drugs subsidise the expensive ones. It's a contribution towards the total cost for everyone and I'm pretty sure there's still a shortfall. I have a prepayment so I pay £110 a year and I get all my meds for that which I have a baseline of about 28 prescriptions a year plus any extra treatments so it works out much cheaper than individual charges. There's also an HRT only prepayment now that costs about £20 IIRC and gives you all your HRT for a year but only HRT.
gameofgroans_@reddit
The fact that inhalers aren’t included as a need to get free prescriptions like other drugs constantly baffles me. Was too poor to afford them a few years back and now trying to get back in the habit is so bad, could’ve saved a couple trips to A&E too.
I now have the payment certificate and am fine but still.
True_Peanut_8092@reddit
Yeah. The problem is if you have one of the qualifying conditions then all your drugs are free. And there's a hell of a lot of people with asthma. So although those drugs are cheap, they don't want to lose the funding from them (and because they're cheap, the contribution towards other drugs is more valuable).
We had a friend when I was younger who couldn't afford her inhalers (but was working so didn't qualify for free prescriptions) and so ended up in hospital half a dozen times a year. It would have been so much cheaper to have just given her free puffers than yo pay for hospitalisation.
Purplemonkey78@reddit
It’s an inherently unfair system. Diabetic? Have everything for free. Asthma? Sorry you need to pay. Under active thyroid, it’s all free. Over active thyroid, you need to pay. The system was designed in the 1950s and has only ever had minor tweaks since.
anonnymouse2025@reddit
Underactive thyroid is on the free list too
Purplemonkey78@reddit
I did mention that in my post. Mainly to highlight that an under active thyroid will give you free prescriptions but an over active thyroid won’t.
anonnymouse2025@reddit
It's a bit mad, isn't it?
Purplemonkey78@reddit
Completely flawed. It’s never been properly overhauled since the current system of exemptions was introduced in 1968. There’s probably a bigger conversation needed around free for everyone vs paid prescriptions, but at least the system in Scotland, Wales and Northern Ireland is fairer at the moment.
Purplemonkey78@reddit
Depends on the medicine. Unbranded salbutamol inhalers cost the NHS around £1.50 but preventer inhalers are more expensive with some around £45-£50 per inhaler. Still much cheaper than the cost of a hospital admission due to an asthma attack.
You can check the cost of generic (unbranded) medicines using the NHS drug tariff. https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/drug-tariff
Rugbylady1982@reddit
It doesn't even cover the cost of the actual meds so it's not even funding itself
Harrry-Otter@reddit
Varies. Something like a packet of amoxicillin will cost the pharmacy significantly less than £9.90. A GLP-1 injection will cost way, way, more than £9.90.
Rugbylady1982@reddit
On an individual basis yes but the NHS drug bill also included things like all prescriptions being free in Wales so when you even it out across the UK and take free prescriptions into account they don't make money.
Radiant_Chart3163@reddit
Prescriptions are also free in Scotland, aren't they?
Quiet_surprise79@reddit
Yes
GrabbedByTheGhost@reddit
How are the Scottish ones funded?
TurbulentContext@reddit
At the time prescriptions were abolished in Scotland the government's position was that the admin to check who was and wasn't entitled to free prescriptions was much more than the actual money brought in by folk paying for prescriptions. So abolishing them actually saved money they put into free eye tests or one of the other policies.
kiradax@reddit
We pay more tax and get free prescriptions and free tuition
Radiant_Chart3163@reddit
That makes sense.
GrabbedByTheGhost@reddit
I seeeeeee
Pixiebel81@reddit
And Northern Ireland
Radiant_Chart3163@reddit
I never knew that.
Rugbylady1982@reddit
No idea I live in Wales.
Colleen987@reddit
Only England pays for prescriptions. As healthcare is devolved there is no central "drugs list" because there is no central NHS.
somst-over@reddit
Prescriptions being free in Wales is funded by the Welsh government, for NHS Wales. Doesn't affect NHS England's drug bill.
fussyfella@reddit
It is not even that simple (it's the NHS bureaucracy what do you expect). The pharmacy which prescribes the medicine will reclaim the cost of the medicine from the NHS at a fixed rate for the medicine, so if they can buy it in cheaper than that fixed rate they will make a profit on the deal - which is what happens for most drugs, but there are a few they actually lose money on (that does not normally last long, but it happens). The prescription charge effectively goes straight to the NHS, although to stop two payments happening in different directions, the pharmacy will net off receipts from the money claimed back for the drugs.
Obviously that is in England, as there are no prescription charges in the rest of the UK.
ceehred@reddit
Depends on the meds, I think. Was prescribed a couple of over-the-counter things in my 30's - which the pharmacist advised would be cheaper (than the £8 fee, then) to buy off-shelf.
For chronic conditions, where prescription costs might be free, I get the impression that this encouragement for a person to take the meds might be cheaper for the state to fund rather than taking the hit for the cost of dealing with the longer-term possibilities later on. Though, perhaps, in the hope that the patient might instead die of something cheaper :-D
VolcanicBear@reddit
Depends. You can get an asthma inhaler over the counter in Portugal for €3 or so. I expect it still balances out towards "doesn't cover it" in general, but a lot of medication is cheaper than you'd think.
Rugbylady1982@reddit
It is, you then have the other side, my Chrohns medication is free (to us obviously) but the dose I am on is costing almost 2k every month now I am back to every 4 weeks
Williamishere69@reddit
Yeah, one of the medications my dad is on costs almost 6k per month (28 days). I dont know his dose on another one, but it costs about 1.5k if hes on the lowest mg tablets available for 28 days.
My own medications only cost about £2.50 a month. I get one privately and it literally costs me like 50 quid per month (medication alone, this doesnt include appointments and stuff, so its not more expensive because of that). If the NHS prescribed it, itd only cost them 28 a month.
Its kinda wacky tbh with everything..
Sloter@reddit
Depending on what the drugs are it sometimes does cover them (individually).
Rugbylady1982@reddit
On an individual basis yes but the NHS drug bill also included things like all prescriptions being free in Wales so when you even it out across the UK and take free prescriptions into account they don't make money
Purplemonkey78@reddit
There is no single NHS organisation across the UK. Healthcare is devolved with England, Scotland, Wales and Northern Ireland funding and running their own healthcare services. I work in the NHS Scotland but grew up in England where I still have family working for the NHS there. These are two very distinct organisations. Fees raised from prescription charges in England do not go towards subsidising the cost of prescriptions in England or Wales.
Deep_Banana_6521@reddit
the medicine costs more than £9.90, that's just the fee they charge you.
If it wasn't for the NHS the cost of the medication would be much higher.
Infact a lot of pharmacists will tell you if medication is cheaper OTC than on prescription. I got prescribed Voltarol once and the pharmacist refused to give it to me and sold me generic Ibuprofen cream for £4 a tube instead.
Jesisawesome@reddit
Question: are you exempt from ALL prescription charges, or just those relating to diabetes?
JuniperScents@reddit (OP)
Fully exempt, it requires a certificate card which no pharmacy asks to see.
gt94sss2@reddit
If you are medically exempt, it covers all prescriptions.
Jesisawesome@reddit
Oh good
Gelkoid@reddit
Our prescriptions are free in Scotland.
BywydBeic@reddit
Yep, same in Wales too.
DrHydeous@reddit
Most prescriptions are free in England too.
kelleehh@reddit
Depends on your age and job status.
DrHydeous@reddit
Yes, and most prescriptions are, as a result, free.
Purplemonkey78@reddit
I appreciate this may be a slightly out of date but may still be relevant. I’m a pharmacist living in Scotland. Prescription charges were abolished in Scotland in 2011. Before this prescription charges were roughly the same as in England.
Pharmacies buy stock to hold on their shelves. They only get reimbursed for that stock once a prescription is dispensed and a claim for that prescription submitted to the NHS. When a patient paid a prescription charge, that money went into the pharmacies till but the charge would be deducted from any reimbursement received from the NHS. The charge was never designed to cover the cost of medicines but support the cost of overall treatment.
There’s still a lot of debate around prescription charges. The current system still in use in England was designed in the 1950s and seems to contain an arbitrary list of exempt conditions. For example if you have an under active thyroid then all your prescriptions are free. If you have an over active thyroid gland then sorry, you have to pay.
I remember speaking to patients who’d handed me a prescription with three medicines on asking which were the most important as they couldn’t afford the charges on all. Unfortunately prescription charges have been directly highlighted as a factor in some asthma deaths: https://lowdownnhs.info/news/girl-dies-because-she-cant-afford-inhaler-study-shows-thousands-more-at-risk/
But there is evidence to suggest that removal of charges may increase unnecessary waste as it removes any perceived monetary value from a patients perspective with regards to medicines. I.e. there’s no direct consequence to ordering a medicine that might not actually be needed.
TyphoidMurphy@reddit
Good job patients don't get to prescribe themselves medicine then isn't it
zapering@reddit
Right? Am I missing something? It's not like I can rock up to a pharmacy and decide which prescription meds I want, it's not Tesco
BCMM@reddit
A lot of pharmacies have this sign up about the prescription charge, or their own version if it. I think it provides a decent summary:
charges on behalf of Government [sic] and the NHS.
The NHS pays the pharmacy for the medicine, which almost always costs more than the prescription charge.
GrabbedByTheGhost@reddit
It goes to the drug companies who supply the drugs to the NHS.
Some prescriptions cost a lot less than the drug they're providing access to, others cost a lot less.
Not having in-house drug manufacturing is one of the biggest miss-steps in the NHS history
Purplemonkey78@reddit
That’s not quite accurate. Community Pharmacies buy the majority of medicines from Pharmaceutical Wholesalers who in turn buy medicines from manufacturers. Pharmacies will submit a claim for medicines dispensed against an NHS prescription and be reimbursed against fixed prices. Those reimbursements will have any prescription charges paid by patients deducted from the total sum received.
GrabbedByTheGhost@reddit
Yes I knew it was something like that, thanks for the additional clarification
Monkeylovesfood@reddit
It goes into the general budget much like almost everything else.
Prescription costs are north of 20bn with prescription charges generating around 5-7mn.
Unhappy-Giraffe-563@reddit
Paying out negligence cases
Unhappy-Giraffe-563@reddit
In 2024/25, the NHS paid about £3.1 billion in total for negligence claims (including legal costs). Of that, roughly £2.3 billion was direct compensation to patients, with the rest covering legal and administrative costs.
JuniperScents@reddit (OP)
Shocking.
Colleen987@reddit
Only England pay for prescription. But it goes to the pharmacy you are getting the prescription from.
quellflynn@reddit
nope. the money goes to the NHS.
Colleen987@reddit
No it doesn’t. The pharmacy pay a tax and recoup it from the prescription fee.
quellflynn@reddit
they pay 9.90 tax? per prescription?
Colleen987@reddit
The pharmacy through is paid by the NHS for dispensing on a tariff basis. They pharmacy hold that medication and when they give it to customers they claim the cost of dispensing based on the tariff system. If it was dispensed via an exemption the exemption certificate goes in with it that recoups the extra funds that haven’t been recovered from the prescription charge.
quellflynn@reddit
gotcha. the pharmacy gets the prescription money, and they get paid by the NHS and they pay a tax to the NHS.
sounds like a pharmacy is a win win situation.
jeminar@reddit
A pharmacy gets money from the NHS for every prescription it fulfills. That money varies depending on the drug but is usually a bit more than the cost to cover admin etc.
The pharmacy needs to buy the drugs out sells. Large pharmacies can buy cheaper than small ones.
The £9.90 doesn't really have anything to do with the pharmacy or the drug. Pharmacies are required to collect it on behalf of the NHS where it's due, but essentially it's a donation to the NHS paid by some.
ceb1995@reddit
Pharmacy keeps the money then the NHS deducts that amount from the money they pay them for the drugs they claim for. It varies on area demographics but when I worked in one it d be rare for more than 20 items to be paid for a day (not including those that pay with a pre payment certificate).
Opening_Nose_2347@reddit
The NHS has to pay for the drugs.
Cultural_Tank_6947@reddit
Basically goes back into the pot of money.
I know why they do it, but basically only 10% are actually paying for prescriptions in England and Scotland, Wales and NI are free.
However given most pharmacies are technically private businesses, the admin burden on the NHS is quite low.
kupuguy@reddit
There is an official tariff list for NHS prescription items. Whenever your pharmacist issues a prescription they claim the cost of the items back from the NHS according to that price list. If the prescription involved a charge to the patient that is deducted from the amount they can claim.
So, no, it doesn't go to the pharmacist, they get the same money (eventually) whether or not you pay for the prescription. It does kind of go to the NHS because the pharmacist is paid less for issuing a paid prescription than a free prescription.
fortyfivepointseven@reddit
This isn't really how budgets works. All the money gets mixed together in the bank accounts and it's not really possible to say, "this money paid for this thing".
Sometimes funders 'ringfence' funding and so in those cases there's a relationship between the income and expenditure.
However, in general it's more of a case of the NHS having income and outgoings, and the relationships between one and the other are quite vague.
Jamie2556@reddit
My local boots has a sign up saying that the prescription charge is a tax set by the government and has no link to them as a pharmacy or to the cost of your medicines.
Over-Language2599@reddit
I would think most of that goes towards the admin costs of both the GP and the pharmacy in issuing the prescription. Probably all of it really.
HawkwardGames@reddit
Towards the overall cost of running NHS prescriptions, basically. It’s not like the pharmacist just pockets the £9.90. The NHS pays pharmacies separately for dispensing/services, and the prescription charge just offsets some of the wider cost.
Old_Quit_851@reddit
Towards the cost of the actual drugs..,,
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