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Mathew Crowther, head of medical and regulatory affairs at Tillotts Pharma UK, looks at prescription charges through the eyes of inflammatory bowel disease.
Prescription charges have been politically divisive since their reintroduction in 1968. Today, England stands alone as the only UK nation still charging for prescriptions, with patients paying £9.90 per item, while Scotland, Wales and Northern Ireland have abolished fees entirely.
For many, this is not a minor inconvenience but a recurring financial hurdle. Patients with chronic conditions often require multiple prescriptions each month, meaning costs quickly accumulate. In the context of the ongoing cost of living crisis, these charges risk becoming a persistent barrier to accessing essential treatment.
But the impact goes beyond affordability. Prescription charges are a health risk. When patients are unable to access the medicine, the consequence is felt not only by the patient but across the health system.
The prescription charge landscape
As we all know too well, treatment adherence can be key to preventing complications that are often more costly and challenging to treat in the long term. And while there are a number of reasons why patients may choose not to take medication, whether that be intentional or not, removing the barriers to access is a crucial step in the right direction.
A 2023 survey by the Prescription Charges Coalition, involving 4,000 people with long-term conditions, found that nearly one in ten had skipped medication due to cost, while over half reported taking time off work because their condition had worsened. This highlighted a clear and troubling dynamic whereby some patients were forced to choose between medication and other essentials.
While the government points to “extensive arrangements” to support affordability, these measures fall short in practice. Prescription prepayment certificates (PPCs), for example, are designed to cap costs, yet uptake remains low. In 2023-2024, only one in three patients who could have saved money by using a 12-month PPC did so. This suggests a need to provide clearer information and communication around access to PPCs, particularly for those with fluctuating conditions, where treatment needs vary month to month, and PPCs may not always offer them a benefit. We heard first-hand at an event in the House of Lords in November last year that patients report difficulty justifying upfront costs when their medication requirements are unpredictable.
At the same time, the medical exemption list, which determines eligibility for free prescriptions, is fundamentally outdated. Introduced in 1968 and largely unchanged since, it fails to reflect modern clinical understanding. While cancer was added in 2009, many long-term conditions remain excluded.
Inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, is not included on the exemption list and illustrates the consequences of this outdated approach. Nearly half a million people in the UK live with IBD, with around 25,000 new diagnoses each year. Most are diagnosed between the ages of 15 and 40, meaning they can face decades of managing a complex condition while continuing to pay prescription charges throughout much of their adult lives.
This impact is felt not only by individuals, but also by the NHS. Hospital admissions related to IBD have risen significantly in recent years, increasing by over 26% between 2019/20 and 2023/24. Many of these admissions will be preventable if the condition is well managed. A 2018 York Health Economics Consortium model estimated that removing prescription charges for IBD patients could save the NHS around £20 million annually through fewer relapses, reduced complications and lower demand for acute care.
The chronic cost campaign
In response to these challenges, we launched the chronic cost campaign, which is highlighting the impact of prescription charges for IBD patients in England. While scrapping prescription charges remains our ultimate goal, years of advocacy have delivered limited traction in Westminster. To make progress, we need to find new ways to shift the debate further up the political agenda.
The immediate priority is securing a government commitment to review the medical exemption list. Despite repeated calls, the government has confirmed it has no plans to review the exemption list and no formal mechanism to trigger such a review.[i] 58 years is far too long to wait for a review of a list of ever-evolving medical conditions.
Alongside this, there is a need to strengthen the evidence base. While existing analysis demonstrates potential NHS savings, accumulating more up-to-date, condition-specific data is essential to shift the debate.
To address this, the campaign has launched a new patient survey to build a clearer picture of how prescription charges affect people living with IBD today. It is also calling on the government to assess the cost-effectiveness of removing charges for IBD formally.
Ultimately, this is about reframing the narrative from cost to value. Improving access to medication is not simply a benefit for patients, it is an investment in public health, better outcomes and a more sustainable NHS.
This campaign isn’t just about IBD, it’s about protecting patients and ensuring they are able to manage their condition. But we can’t do this alone.
[i] UK Parliament. 2026. Written Question: Prescription Charges, UIN 102313. Available at: https://questions-statements.parliament.uk/written-questions/detail/2026-01-02/102313 [Accessed July 2026].
