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Review of prescription charges

By Mike Broad - 21st April 2009 11:08 am

In April, prescription charges for cancer patients in England were abolished.

While oncologists are relieved that the government has removed a significant deterrent to their patients accessing appropriate medicines, others want further reform of the charging system. All other conditions subject to prescription charges remain unchanged, despite evidence suggesting the system is both iniquitous and detrimental to patients’ health.

Many ask why cancer should be exempted when asthma, multiple sclerosis and mental health problems aren’t? These also involve the kinds of people who cannot afford the medicines they need – with the prescription charge increasing to £7.20 for 2009/2010 – which can lead to further problems with unplanned hospital admissions.

Back in 2001, research by the Citizens Advice Bureaux showed that 28% of those who had paid charges failed to get all or part of the prescription dispensed because of the cost. This was estimated to be about 750,000 people, with single parent households and those with long term conditions being worst affected.

Then in 2006, Royal Pharmaceutical Society of Great Britain research suggested that patients couldn’t understand the rationale on exemption and felt the charge was too high, particularly for those taking multiple medications.

Wales introduced free prescriptions in April 2007, and Scotland and Northern Ireland are currently reducing charges prior to free prescriptions in April 2011 and April 2010 respectively.

In England, the government has set up a review of prescription charges – led by Professor Ian Gilmore, president of the Royal College of Physicians – to consider which long-term conditions should be exempted. But, it is not the fundamental review of the purpose and value of prescription charges that many would like to see.

The BMA is calling on the Department of Health to abolish prescription charges in England altogether.

It claims that the current exemption categories are often illogical and unfair, and extending these categories to include long-term conditions will add to the inequities in the system and create new ‘winners’ and ‘losers’.

Legislation providing for prescription charges was not passed until the Labour Government’s NHS (Amendment) Act 1949. This enabled such a charge, and exemptions to it, to be introduced by regulations. Although the power was introduced in 1949, the charge itself was not introduced until 1952, under a Conservative Government. Apart from a period between 1965 and 1968, a prescription charge has continued in England ever since.

The current list of exemptions has been unchanged since then and does not reflect changes in medical treatment.

The BMA highlights exemption inconsistencies. Patients on thyroxine replacement therapy for an under active thyroid are exempt from charges, despite it being a cheap drug, while those with asthma and heart disease, who may require multiple medication for a prolonged period, are not. Similarly cystic fibrosis, which requires people to take a large number of drugs throughout their life, is not exempted because 40 years ago patients didn’t survive beyond childhood.

Defining a modern, definitive list of exempted chronic diseases is not easy, and is complicated by increasing polypharmacy and comorbidity.

But then scrapping prescription charges is not yet considered an affordable policy option for the NHS. While only 11% of prescriptions attracted a charge (and this will have lowered with cancer’s exemption), this still generates £450m per year in revenue. Cancer’s exemption will reduce this by about £16m a year.

Jonathan Fielden, chair of the BMA’s CCSC, said: “In NHS terms the revenue from prescription charges is a relatively small sum and comes with immense bureaucracy,” he said.

“It means some individuals are parting with considerable amounts of money to treat their conditions while others, with similar health burdens, are not. It would be more equitable if charging were done away with altogether. Instead of spending money on PFIs or the private sector, we should invest in scrapping prescription charges.”

The Government is clearly opting to take the middle ground agreeing that access to certain medicines needs to be improved, calling for a fairer system of prescription charging in England and setting up a review limited to long term conditions.

If, of course, its findings prove insubstantial or inconsistent when it reports to the health secretary this summer then pressure will continue to mount for a full review of the prescription charging system.

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