Pharmacy teams need to ensure they are checking exemption status in order to help patients correctly fill in the back of the prescriptions.
Below is relevant information to help pharmacy teams in checking claims.
What pharmacy staff must do
Pharmacy staff are reminded that unless patients are exempt by age and the date of birth on the prescription is computer generated, the patient is required to complete the exemption declaration and pharmacies are required to check for proof of a patient’s exemption status at the point of dispensing.
At the point at which the patient is asked to declare their exemption and the patient makes a declaration on the back of the prescription form, the patient must hold the required proof of exemption, and this must be within its period of validity – pharmacy staff are expected to check evidence of entitlement.
If the patient is unsure of whether they are entitled to free prescriptions, pharmacy staff should ask them to pay for the prescription, and issue them with an FP57 prescription receipt and refund form and signpost them as to how they can obtain the necessary certificate. This enables the patient to receive a refund of paid prescription charges once they have obtained the necessary certificate. This can be processed at any community pharmacy.
Where appropriate, pharmacy staff should advise patients of the required certificates and how they might go about obtaining them (e.g. Medical Exemption Certificates required for patients suffering from diabetes, epilepsy etc. as well as exemption certificates on maternity grounds, low income, or Prescription Prepayment Certificates (PPC)).
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. Pharmacy staff need not refuse to dispense items on the basis that the patient does not provide evidence of their entitlement to free prescriptions.
The patient is responsible for the accuracy of the declaration they make. NHS Protect have a responsibility to check for prescription charge exemption fraud and patients found to have wrongly claimed for free prescriptions, could face a penalty charge and in some cases prosecution. This applies even where the patient has a medical condition which qualifies for exemption, if the patient does not have a valid exemption certificate on the date the patient is asked to pay or complete the exemption declaration.
Pharmacy staff may consider holding application forms for some of the certificates such as those for patients who may be eligible for the NHS low income scheme or prescription prepayments. The table below outlines how to obtain some of the common forms and resources.
For further information visit the PSNC page on exemptions – www.psnc.org.uk/exemptions
NHSBSA Help with Health Costs – www.ppa.org.uk/ppc