Summary:
Applying prescription charges in England for the over 60s, with the same criteria as those under 60 years of age, would address inequalities in society, reduce excess prescribing and ease the burden on the NHS drugs budget.
What are the issues?
The over 60s are the main consumers of prescription drugs and their free prescriptions can be a causal factor in over prescribing. It is estimated that more than 60% of the prescriptions made in the community are for people aged over 60, yet the over 60s represent less than a quarter of the population.
Household cupboards can be full of unused drugs and with free prescriptions there is little incentive to carry out regular drug regime reviews. In many cases taking fewer drugs can improve health and increase compliance with a prioritised, more manageable regime.
There is growing inequality between those living on earned and unearned income and this has been exacerbated during the Covid-19 pandemic. It can be that those over 60 or retired are relatively better off than those who are younger and working.
The over 60s do not pay for their prescriptions, whereas families with dependent children (aged 18 or above, at school or in further education) can be faced with trying to fund prescriptions for a whole family on a limited income. Older people can be suffering poor health from excessive prescribing, along with wasting unused drugs stored in their cupboards. Conversely younger people can be damaging their health by being unable to fund their prescriptions when required.
How can these be addressed?
So, what is the rationale in England for providing prescriptions free of charge for the over 60s when they are the main consumers? There are already exemptions for under 60s with some chronic health conditions and for those on lower incomes. These exemptions could be applied to the over 60s in the same way as the under 60s, so those on lower incomes would still receive free prescriptions. The NHS Prescription Prepayment Certificate (PPC) provides a good value safety net, at £108.10 p.a. from April 2021, especially for those requiring multiple drugs.
With an NHS drugs bill of around £20bn, excluding the exceptional costs incurred by the Covid-19 pandemic, it is appreciated that the income from prescription charges in England is just a small contribution. However, paying for drug prescriptions raises awareness of their value, encourages timely drug reviews and scrutiny, by prescribers and users, of whether they should be prescribed and dispensed. The same payment regime for those under and over 60 years of age would help to address some of the inequalities in society, reduce the NHS drugs bill and increase funding. Over 60s are the main consumers of drugs, so prescription pricing should reflect this!
How could this change be implemented?
Learning from the introduction of the TV licence fee for the over 75s, it is appreciated that such changes can be unpopular. Regrettably, this proposed prescription charge for older people could be used for political gain. To implement the change and harness its significant benefits, it could be proposed along with improved benefits for other groups in the population. For example, all 18 year olds in education could be exempted from prescription charges. The list of chronic diseases qualifying for exemption could be updated and improved. It could become an inquiry of the cross-party Health and Social Care Committee, with the changes implemented being based on their conclusions and recommendations.
2049-11