More patients are failing to collect prescriptions, asking which medications they can ‘do without’ and asking for cheaper alternatives, a survey by the Royal Pharmaceutical Survey (RPS) has suggested.

Over the last six months, pharmacists have seen more patients asking which medicines on their prescription they can 'do without' due to cost, half of the survey respondents said.

Two out of three pharmacists said that they had seen an increase in people asking if there was a cheaper, over-the-counter alternative for the medicine that they had been prescribed.

And half of the 269 pharmacists who responded to the survey, which was sent out to RPS members, reported a rise in people not collecting their prescriptions.

Prescription charges were frozen last year, so patients in England currently pay a flat rate of £9.35 per item prescribed unless they are eligible for an exemption.

Patients can also buy a pre-payment certificate, which costs £30.25 to cover prescriptions for 3 months or £108.10 for 12 months.

Prescriptions are free for people in Scotland, Wales and Northern Ireland. The RPS said that the system should be overhauled in England to make prescriptions free for people with long term health conditions.

Thorrun Govind, chair of the RPS in England, said: ‘We are deeply concerned that people are having to make choices about their health based on their ability to pay. No one should have to make choices about rationing their medicines and no one should be faced with a financial barrier to getting the medicines they need.

‘Prescription charges are an unfair tax on health which disadvantages working people on lower incomes who are already struggling with food and energy bills.

‘Prescriptions have been free for people in Scotland, Wales and Northern Ireland for many years. We urgently need an overhaul of the system in England to ensure it supports access to medicines for people with long-term conditions at the sharp end of the cost of living crisis.

‘Ultimately we want to see the prescription charge abolished for people with long-term conditions so medicines are free to access in England, just like they are in the rest of the UK.’

In 2021, the government consulted on proposals to raise the prescription age in line with the state pension age.

‘In 2019/20, around 60% of people in the 60-65 age group were still economically active and potentially able to meet the cost of their prescriptions,’ the Department for Health and Social Care said in an impact assessment at the time.

‘Changing the upper age exemption will raise significant extra revenue for the NHS which found itself under unprecedented pressure in 2020,’ the department added.

However, it said that changing the guidelines around free prescriptions ‘would affect some lower income groups more severely, though patients with the lowest incomes would remain protected by income-related exemptions’.

NHS England estimates that 90% of prescriptions in the community are dispensed for free under various exemptions to charges.

In 2017, over 8bn items were dispensed under free prescriptions – 61.6% to the elderly, 4.1% to young people and 8.3% to people with a maternity or medical exemption certificate.

Plus, 11.7% of free prescriptions went to patients on a low income under the NHS Low Income Scheme, which currently gives free prescriptions to those earning under £16,000 each year.

In total, 10.2% prescriptions in 2017 were paid for by patients, either under pre-payment certificates or at the point of dispensing, which brought in around £952m to the NHS.

The total cost of those prescriptions, as set out in the drug tariff, was around £1.1bn, making up 11.1% of the overall Net Ingredient Cost, which in 2017 was around £9.2bn.

In 2017, prescriptions in primary care cost the NHS around £8.1bn, based on reimbursement of the drug tariff and single activity fees. This figure rose to around £8.4bn in 2021/22.

But in a statement accompanying the RPS survey results this week, Ms Govind said that any money saved by charging patients for prescriptions must be considered alongside the cost of poor health, particularly if patients chose not to collect their prescriptions due to the cost.

‘Reducing access to medicines leads to poorer health, time off work and can result in admissions to hospital, the cost of which must be set against any income gained from prescription charges,’ she said.

In January, a Healthwatch survey found that one in ten patients have avoided taking up an NHS prescription because of cost, while the same number avoided buying over-the-counter medication they normally rely on.