Cancer Patient Prescription Charge Exemption
From 1st April 2009, exemption from prescription charges on medical grounds will be extended to patients who are undergoing treatment for cancer, the effects of cancer or the effects of cancer treatment.
Who is exempt? The regulations will be changed to state: “No charges shall be payable by a person with a valid exemption certificate issued by the Secretary of State on the ground that the person is undergoing treatment for –
- (i) cancer;
- (ii) the effects of cancer; or
- (iii) the effects of cancer treatment”.
The Department of Health has provided doctors with detailed guidance on the meaning of the words used in the regulations, however interpretation is a matter for a doctor’s clinical judgment in deciding whether or not to confirm the patient’s statement and sign the application form.
The DH guidance defines ‘cancer’ as diagnosed cancer (any cancer), not suspected cancer and states that ‘the effects of treatment for cancer’ may be in respect of current treatment or previous treatment and could arise some time after the treatment, for example late effects of radiation.
Once a patient has a medical exemption certificate, this exempts them from charges for all NHS prescription items, not just those for the exempting condition.
If a cancer patient pays a prescription charge on or after 1st April pending the receipt of an exemption certificate, they should be issued with an FP57 refund form so they can claim a refund when their exemption certificate arrives.
How do patients apply? Patients will be able to apply for medical exemption certificates using application form FP92A (January 2009 revision) which they can get from their GP surgery or oncology centre. Exemption certificates will be backdated one month from the date the application is received but cannot start before 1 April in respect of the cancer exemption.
Certificates run for 5 years and can be used until the end date shown. A reminder will be issued automatically to the patient and the certificate may then be renewed if the qualifying conditions still apply. Certificates do not have to be returned if the patient’s condition changes, however they should be returned on the death of the patient to ensure no further reminders are sent.
Can patients obtain refunds for pre-payment certificates? If necessary, patients can apply for proportional refunds of prescription pre-payment certificates that have previously been purchased. To claim a refund, patients should send the original certificate to the NHS Business Services Authority, PPC Issue Office, PO Box 854, Newcastle-upon-Tyne, NE99 2DE, stating the reason for the refund claim. Additional guidance on the process for claiming a refund can be found in the HC11 (Help with Health Costs) leaflet.
Proof of Exemption? Pharmacy staff are required to check at the point of dispensing whether patients have evidence of their entitlement to free prescriptions. Appropriate evidence of exemption for cancer patients exempt under the medical exemption would be their Medical Exemption Certificate. Where patients do not have evidence or where there is doubt over whether the evidence provided is appropriate, the ‘Evidence not seen’ box on the back of the prescription should be marked with an X by pharmacy staff. If a valid certificate of exemption has been shown and noted on the PMR along with the certificate’s expiry date, it is not necessary to ask the patient to show proof again within the validity of the certificate.
Posted 20 January 2009