Prescription Exemption Certificates: HC2, HC3, PPC and Automatic Exemptions

The NHS prescription charge in England is £9.90 per item (since April 2025). Around 89% of dispensed prescriptions are free. The system divides into:

• Automatically exempt — by age, condition, or benefit status.
• Exempt with a certificate — medical exemption, maternity exemption, or low-income certificate.
• Pay reduced cost — via the Prepayment Certificate (PPC).
• Pay full cost — usually working-age people aged 19-59 who do not have a qualifying medical condition and are not on means-tested benefits.

The cost falls heavily on a specific group: working-age people just above the means-tested benefits threshold, with one or more chronic conditions, but who do not qualify for medical exemption. The PPC is designed to help this group.

You are automatically exempt and do not need a certificate if:

• You are under 16.
• You are 16, 17, or 18 and in full-time education.
• You are 60 or over.
• You are pregnant or have had a baby in the last 12 months (you do still need a Maternity Exemption Certificate — see below).
• You are an inpatient receiving NHS treatment.
• You are receiving NHS-funded prison healthcare.

Tick the appropriate box on the back of the prescription. The pharmacy may ask for proof — typically driving licence for age, ID for student status.

You qualify for a Medical Exemption Certificate if you have one of the conditions listed in the NHS (Charges for Drugs and Appliances) Regulations 2000 Schedule 1:

• Permanent fistula (colostomy, ileostomy).
• A form of hypoadrenalism (e.g. Addison's disease) requiring specific substitution therapy.
• Diabetes insipidus and other forms of hypopituitarism.
• Diabetes mellitus (except where treated by diet alone).
• Hypoparathyroidism.
• Myxoedema and other conditions requiring specific replacement of hormones.
• Myasthenia gravis.
• Epilepsy requiring continuous anticonvulsive therapy.
• A continuing physical disability that prevents you leaving home without help.
• Receiving treatment for cancer, the effects of cancer, or the effects of cancer treatment.

Apply via your GP using Form FP92A. The certificate is valid for 5 years and renewable on application.

Many conditions that you might expect to qualify do NOT — asthma, mental health conditions, heart failure, COPD, arthritis, HIV. There is long-running political campaigning for expansion of the list, but no changes have been made for many years.

The Low Income Scheme provides:

• HC2 certificate — full exemption from prescription charges, dental treatment, NHS sight tests, glasses, NHS wigs and fabric supports, and travel to hospital for treatment.
• HC3 certificate — partial help; you pay reduced rates.

Apply on Form HC1 (download from gov.uk or get from pharmacies and GPs). The form assesses your income against expenses. It is means-tested but more generous than the benefit thresholds — many working families qualify.

HC2 entitlement is also automatic if you receive:

• Universal Credit (specific income thresholds apply — see HC2 form).
• Income-based Jobseeker's Allowance.
• Income-related Employment and Support Allowance.
• Income Support.
• Pension Credit Guarantee Credit.
• Working Tax Credit with Child Tax Credit, or Working Tax Credit including the disability element or severe disability element, if your annual income is £15,276 or less.

The Prepayment Certificate is for people who pay for prescriptions but use many of them. The 2025-26 prices:

• 3-month PPC: £32.05. Covers unlimited prescriptions for 3 months. Saves money if you need 4 or more items in that period.
• 12-month PPC: £114.50. Saves money if you need 12 or more items in a year. Can be paid in 10 monthly direct debit instalments of £11.45.
• HRT PPC (new in 2024): £19.80 for 12 months, covering all HRT items only. Significant saving for women on long-term HRT.

Buy at nhsbsa.nhs.uk/exemptions/buy-prescription-prepayment-certificate or by phone on 0300 330 1341. The certificate covers you from the date of purchase forward. You can buy and use immediately — no waiting period.

If you start a PPC mid-prescription, the pharmacy will let you keep the receipt — refund claim within 3 months using form FP57 if you can prove the PPC was active when you paid.

Five issues that lead to wrongly-paid prescription charges:

• Not knowing about MedEx for your condition — particularly diabetes, where many people don't apply because they assume their GP will arrange it. The GP must initiate the FP92A.
• Wrongly ticked exemption box — leads to penalty charge notice. The NHS sends £100 fines for incorrect declarations. Always check the rules on the back of the prescription form.
• Missing the HC1 income-based scheme — many low-income working families don't know they qualify. Try HC1 if you are on benefits or earning below the average.
• Paying for prescriptions while waiting for a MedEx — claim back retrospectively using FP57. The pharmacy gives the form when you pay.
• Not buying a PPC for chronic conditions — if you need 12+ items a year, the 12-month PPC at £114.50 saves £4.40 per item past the 11.6th item.