NHS Prescription Charges in 2026: Who Pays, Who Doesn’t, and Why

Two patients walk into two community pharmacies on the same Tuesday morning in April 2026, holding identical prescriptions for the same generic statin. One is in Cardiff. The other is in Bristol. The Bristol patient pays £9.90. The Cardiff patient pays nothing. Same NHS, same medicine, two very different bills.

The reason is devolution. Prescription charges in the United Kingdom are set separately by each of the four nations, and they have diverged sharply over the past two decades. Wales abolished its charge first, in 2007. Northern Ireland followed in 2010. Scotland completed the move in 2011. England has retained and steadily uprated its charge ever since. This article walks through the current rates, the exemptions that still cover roughly nine in ten dispensed English items, the cross-border rules that nobody seems to know, and the political history behind the divergence.

The current rates (2026)

For the tax year beginning April 2026 the position across the four UK nations is as follows:

• England. £9.90 per dispensed item, set by the Department of Health and Social Care and confirmed annually on NHS.uk. The rate has been frozen at £9.90 since May 2024 (it rose from £9.65 to £9.90 in May 2024 and has been held since). A Prescription Prepayment Certificate (PPC) costs £32.05 for three months or £114.50 for twelve months and covers unlimited items in the period. A separate HRT-only PPC introduced in April 2023 costs £19.80 a year.
• Wales. Free at the point of dispensing for all NHS prescriptions, regardless of patient age, income or residency, since 1 April 2007. Confirmed on gov.wales.
• Scotland. Free since 1 April 2011 under the Scottish Government’s 2008 abolition timetable. See the Scottish Government’s pharmaceutical services policy.
• Northern Ireland. Free since 1 April 2010 under the Health and Personal Social Services Act (NI). Confirmed by the Department of Health NI.

How we got here, briefly

Prescription charges were introduced in 1952, abolished in 1965, reintroduced in 1968 and have been in force across the UK ever since. The 1999 devolution settlements gave Wales, Scotland and Northern Ireland the power to set their own NHS charging regimes, and each took a different political path to abolition.

Wales moved first, under the 2003 to 2007 Labour and Plaid Cymru cooperation arrangement, completing abolition on 1 April 2007. Northern Ireland followed in 2010 under the restored devolved Assembly, ending charges on 1 April 2010 in line with a 2008 Executive commitment. Scotland completed a phased abolition timetable announced in 2008 by the then SNP government, ending the charge on 1 April 2011. England has retained the charge under successive Labour, coalition and Conservative governments; numerous parliamentary debates and private member’s bills proposing abolition have failed.

The fiscal argument has been the persistent counterweight. NHS England raises in the region of £600 million a year from prescription charges and PPC sales. That is small relative to the NHS England revenue settlement (under one half of one per cent), but it is not zero, and there is no obvious non-controversial source of substitute revenue.

Who is exempt in England

Although England retains the charge, the great majority of dispensed prescription items are exempt. The NHS Business Services Authority routinely reports that around 89 per cent of items dispensed in England attract no charge to the patient. The exemption categories, set out on NHS.uk, are:

• Under 16
• 16 to 18 and in full-time education
• 60 or over
• Pregnant, or had a baby in the last 12 months (with a Maternity Exemption Certificate, MatEx)
• Holding a Medical Exemption Certificate (MedEx) for a listed long-term condition: cancer (including the effects of cancer or current cancer treatment), a permanent fistula requiring surgical dressing, diabetes mellitus, diabetes insipidus and other hypoadrenalism, hypoparathyroidism, myasthenia gravis, myxoedema, epilepsy needing continuous anticonvulsive therapy, and a continuing physical disability that prevents the patient leaving home without help
• Receiving income-based Jobseeker’s Allowance, income-related Employment and Support Allowance, Income Support, Pension Credit (Guarantee Credit) or Universal Credit (subject to earnings thresholds)
• Holding a valid HC2 certificate (full help under the NHS Low Income Scheme)
• An NHS inpatient
• A war pensioner whose prescription is for an accepted disablement (under the Veterans’ War Pension exemption)

Conditions outside the MedEx list are a longstanding source of policy criticism. Asthma, Crohn’s disease, multiple sclerosis and many other chronic conditions remain chargeable in England, on a list that has been largely unchanged since the 1960s.

The PPC trap (and how to avoid it)

For anyone collecting multiple paid items each month, the per-item rate adds up quickly. The Prescription Prepayment Certificate solves this:

• 3-month PPC at £32.05. Breaks even at four chargeable items in three months. Anyone collecting two paid items per month is already better off.
• 12-month PPC at £114.50. Breaks even at around 12 items per year. Most patients on regular long-term medication save substantially.
• HRT-only PPC at £19.80 per year. Introduced in April 2023, covers unlimited listed HRT items. Cheaper than the standard PPC for patients who do not need it for other items.

Despite the maths, NHS England estimates that millions of eligible patients in England do not buy a PPC and end up paying more per year than they would with one. The PPC is available online through the NHS BSA portal, by phone, or directly from the pharmacy counter, and the cost can be paid by ten monthly direct debits for the annual certificate.

Cross-border prescriptions

The charge follows the prescriber’s nation, not the dispensing pharmacy. The practical rules:

• A Welsh, Scottish or NI NHS prescription dispensed anywhere in the UK is free at the counter. The dispensing pharmacy claims reimbursement from the issuing nation’s NHS.
• An English NHS prescription dispensed in Wales, Scotland or Northern Ireland still attracts the £9.90 English charge, payable by the patient at the counter unless they hold an English exemption.
• English exemption certificates (MedEx, MatEx, HC2, PPCs) are valid for dispensing in any UK nation when the underlying prescription is English.
• Private prescriptions are not NHS prescriptions and follow the pharmacist’s posted retail price plus the actual medicine cost, everywhere in the UK.

If you are unsure which regime applies (for example as a student living in Glasgow but with an English GP), ask the pharmacist before they dispense. Most counter staff handle cross-border prescriptions every week and will know instantly.

If you cannot afford the charge

There are practical routes if £9.90 per item is unaffordable:

• Apply for HC2 or HC3 through the NHS Low Income Scheme (form HC1). HC2 gives full exemption; HC3 gives partial help. Eligibility depends on household income, savings and outgoings.
• Buy a PPC even on a tight budget: the direct-debit option spreads the £114.50 annual cost across ten monthly payments of roughly £11.45. For patients on more than two items per month, this is cheaper than paying per item.
• Ask the prescriber about the cheapest equivalent. Some medicines are available over the counter for less than the £9.90 charge (paracetamol, low-dose ibuprofen, hayfever antihistamines). If the over-the-counter price is lower, the pharmacy is required to tell the patient.
• Emergency supply provisions. A community pharmacist can supply a limited emergency quantity of a previously-prescribed regular medicine without a fresh prescription. The patient still pays at the counter unless exempt, but no GP appointment is needed.

Why we have this divergence

The principled argument for divergence is straightforward: devolution exists so that the four nations of the UK can choose different paths on non-reserved matters, and health is the largest non-reserved competence. Welsh, Scottish and Northern Irish governments all framed abolition as a public-health intervention to remove a cost barrier between patients and their medicines, particularly for working-age adults on chronic medication who fall outside the MedEx list.

The argument for retention in England is partly fiscal (the £600 million revenue stream is not easily replaced) and partly distributive: the English exemption system already removes the charge for around nine in ten dispensed items, and abolition is, in cash terms, a transfer from non-exempt working-age adults to the general taxpayer. Whether that transfer is fair is a value judgement.

The political reality is that no recent UK government has prioritised abolition. The 2024 Labour manifesto did not propose ending charges; nor did the 2019 or 2017 Conservative manifestos.

What is coming

• 2027 English charge. The April 2027 rate will be set in the March 2027 NHS settlement. The rate has now been frozen at £9.90 for two consecutive years (2025/26 and 2026/27); whether the freeze continues or an above-inflation catch-up follows has not yet been signalled by the Department of Health and Social Care.
• Welsh, Scottish and NI free regimes are politically protected. None of the three devolved governments has publicly considered reintroducing charges. The Northern Ireland Assembly’s health committee has periodically reviewed the policy and reaffirmed it.
• HRT PPC. The April 2023 HRT prepayment scheme is settled policy and continues into 2026 and beyond.
• Pharmacy First and similar minor-ailments services are changing the cost picture for some conditions. A patient seen under Pharmacy First for one of the seven England-listed conditions may receive a treatment free at the point of consultation, sidestepping the prescription charge entirely.

Frequently asked questions