NHS charge notices for prescriptions for claimants on Universal Credit
There has been an increasing number of reports that claimants receiving Universal Credit, and are entitled to free prescriptions through the NHS, have been receiving penalty notices stating that they have incorrectly claimed free prescriptions. Some of the penalty charges have been as much as £150.00.
At the moment there is no tick box on the reverse of the prescription form for claimants to declare they are exempt from charges because they receive Universal Credit. The current guidance states that (if a Universal Credit claimant’s earnings are below the thresholds) the claimant should tick the box stating that they are on JSA (IB). This has been agreed with the Department of Health (DH) and the NHS Business Services Authority (the organisation that processes prescription forms for the purposes of reimbursing pharmacists for dispensing the medication and also operates the Prescription Exemption Checking Service on behalf of NHS England). Communications and guidance has been issued nationally to pharmacists.
What are the eligibility criteria for claimants on Universal Credit to receive help with their health costs?
Help with health costs is a term used to describe a range of exemptions and remissions from NHS charges. Some DWP benefits automatically “passport” an individual to help with their health costs meaning that they are entitled to: free NHS prescriptions; free NHS dental treatment; free NHS wigs and fabric supports; free sight tests and glasses or contact lenses (via optical vouchers); and free travel for NHS treatment (for any additional journey to receive NHS care) following a referral by a doctor, dentist or optician (but not for primary care).
Claimants will qualify if, on the date they claim help with health costs:
- a) they receive Universal Credit, and either had no earnings or had net earnings of £435 or less in their last Universal Credit assessment period;
- b) receive Universal Credit, which includes an element for a child, or they (or their partner) had limited capability for work and work-related activity, and either had no earnings or net earnings of £935 or less in their last Universal Credit assessment period.
For couples, the net earning threshold applies to the combined net earnings.
There is no box on the prescription form for claimants to tick that they are on UC. What should they do?
The prescription form has not yet been amended to include a tick box for a patient to declare that they are entitled to free prescriptions because they are on Universal Credit (and their earnings were below the relevant threshold). Until the prescription form can be amended claimants should tick the “gets income-based Jobseeker’s Allowance” box on the back of the prescription form. This approach has been agreed with NHS and DH, and the advice is shown on the relevant NHS web page. Guidance has also been shared with pharmacies.
Will claimants need to provide pharmacies with proof of their entitlement?
Pharmacists may well ask to see evidence that claimants are receiving Universal Credit. Claimants can produce their current entitlement letter, or claimants receiving UC in full service areas can show their electronic entitlement (i.e. on their smart phone). We will be working with both DH and NHS to ensure they review the current guidance to pharmacists, and help to improve understanding of the changes under UC.
A claimant has just told me that they have received a notice stating that they must pay a penalty even though they are clearly claiming UC and have ticked the JSA (IB) box.
If a claimant has received the penalty notice, and feels it has been incorrectly issued, then they must make an appeal against the penalty. Full details of how to do this and any supporting evidence the claimant will need is given in full with the penalty notice. The NHS Business Services Authority is not carrying out prescription charge exemption checks on prescription forms where the JSA box has been ticked. So in these cases, no penalty charge notices will be issued. However, there may be penalty charge notices where claimants have ticked the wrong box or have ticked no box at all. We will continue to monitor the situation to investigate any new penalties issued.