B1590 – Prescription Charge Abolition Bill 2020 (Second Reading)

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Andrew97
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B1590 – Prescription Charge Abolition Bill 2020 (Second Reading), TSR Liberal Democrats, TSR Labour Party

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Prescription Charge Abolition Bill 2020

An Act abolishing prescription charges for everyone in England.

BE IT ENACTED by the Queen's most Excellent Majesty, by and with the advice and consent of the Commons, in this present Parliament assembled, and by the authority of the same, as follows:—

1: Repeal of relevant legislation
(1) Section 131 of the National Health Service Act 2006 is repealed.
(2) Paragraph 172(1)(a) of the National Health Service Act 2006 is amended to 'the supply under this Act of appliances (including the replacement and repair of those appliances), and'.
(3) Paragraph 172(1)(b) of the National Health Service Act 2006 is repealed.
(4) Paragraphs 173(1)(a) and 173(1)(b) of the National Health Service Act 2006 are repealed.
(5) Section 178 of the National Health Service Act 2006 is repealed.

2: Repeal of relevant regulations
(1) Paragraphs 3(1)(c), 3(2)(c), 4(1)(c), 5(1)(c), 6(1)(e) and 7(1)(c) of the National Health Service (Charges for Drugs and Appliances) Regulations 2015 are repealed.
(2) Section 8 of the National Health Service (Charges for Drugs and Appliances) Regulations 2015 is repealed.
(3) Paragraph 9(1)(e) of the National Health Service (Charges for Drugs and Appliances) Regulations 2015 is repealed.

3: Ban on charges
(1) The National Health Service may not levy a charge for prescribed medicines or pharmaceutical services to British citizens or persons normally resident in the United Kingdom, unless under an exception provided for by this Act or the National Health Service Act 2006.
(2) Where a prescribed medicine is available for sale without a prescription in the pharmacy where a prescription is dispensed, the pharmacy may charge for the prescribed medicine.
(2) (a) This charge may be no higher than the sale price of the prescribed medicine, or five pounds, whichever is the lower.

4: Charging of persons not normally resident in the United Kingdom
(1) The Secretary of State may impose a charge for prescribed medicines or pharmaceutical services on persons not normally resident in the United Kingdom, who are not British citizens.
(2) This charge may be no higher than the cost of the prescribed medicine or pharmaceutical service, or ten pounds, whichever is the lower.

5: Definitions
(1) ‘Prescribed medicines’ refers to any medicine prescribed by an NHS doctor.
(2) ‘Pharmaceutical services’ refers to any medical service provided by a pharmacist.

6: Extent, commencement and short title
(1) This Act extends to England.
(2) The provisions of this Act come into force on 1st April 2022.
(3) This Act may be cited as the Prescription Charge Abolition Act 2020.

Notes
This bill follows Wales, Scotland and Northern Ireland and abolishes prescription charges in England, ensuring that medicines prescribed in the NHS are available free at the point of use.

The bill includes exceptions: one for people who are neither UK citizens nor normally live in the UK. A charge may be levied on them.

The second exception is where the patient could have bought a medicine off the shelf or over the counter without a prescription. In this case, a charge of cost or up to £5 can be levied. This is to stop people abusing free prescriptions for medicines that are cheap to buy, such as basic painkillers.

Currently only around one in five people pay prescription charges in England, and only about 10 per cent of prescriptions are paid for. The King's Fund think tank suggest the cost may range from £575m to £750m, though NHS Wales believes that abolition has saved it money.


Changes for second reading
The changes to the NHS Act 2006 are now more selective, to exclude appliances from this reform and restrict it to medicines. A much more selective set of changes to the accompanying regulations are also made to reflect this, with most regulations left in place to cover appliances.

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Theloniouss
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Sensible changes
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Miss Maddie
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I don't like the thought of giving more people free medicines. If it saves money I support it. Does it really save money?
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TheDefiniteArticle
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(Original post by Miss Maddie)
I don't like the thought of giving more people free medicines. If it saves money I support it. Does it really save money?
The King's Fund think tank suggest the cost may range from £575m to £750m, though NHS Wales believes that abolition has saved it money.
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Miss Maddie
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(Original post by TheDefiniteArticle)
The King's Fund think tank suggest the cost may range from £575m to £750m, though NHS Wales believes that abolition has saved it money.
Thank you for repeating the notes to me. I have always struggled reading them!

The question remains unanswered. Does it save money? He said, she said doesn't solve anything.
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adrewp
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(Original post by TheDefiniteArticle)
The King's Fund think tank suggest the cost may range from £575m to £750m, though NHS Wales believes that abolition has saved it money.
(Original post by Miss Maddie)
Thank you for repeating the notes to me. I have always struggled reading them!

The question remains unanswered. Does it save money? He said, she said doesn't solve anything.
Perhaps without the cost of buying the medicines, more people will use their prescriptions. This could potentially be better in the long-run as it could mean that less people are going into hospital with illnesses that could have been prevented with said prescribed medicines.
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Miss Maddie
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(Original post by adrewp)
Perhaps without the cost of buying the medicines, more people will use their prescriptions. This could potentially be better in the long-run as it could mean that less people are going into hospital with illnesses that could have been prevented with said prescribed medicines.
Most of the medication handed out is pain medication, antibiotics for less serious diseases and standard treatments for allergies (hay fever). Enough people suffering hospitalisation that the cost of treating them is more than the cost of their medicine is far-fetched.
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TheDefiniteArticle
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(Original post by Miss Maddie)
Thank you for repeating the notes to me. I have always struggled reading them!

The question remains unanswered. Does it save money? He said, she said doesn't solve anything.
I mean, I'm not sure what you expect. The notes effectively say 'there are a range of costing estimates, here are two examples'. Perhaps Fez is about to come in here with some top-level economics but in my time here referring to studies has always been a valid approach to costing.

The merit of the Bill largely lies in ensuring access to medicine, and that comes at something between a marginal cost and a marginal saving.
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Miss Maddie
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(Original post by TheDefiniteArticle)
I mean, I'm not sure what you expect. The notes effectively say 'there are a range of costing estimates, here are two examples'. Perhaps Fez is about to come in here with some top-level economics but in my time here referring to studies has always been a valid approach to costing.

The merit of the Bill largely lies in ensuring access to medicine, and that comes at something between a marginal cost and a marginal saving.
I expected more than a quote from a politician and a link to a opinion post by a political commentator (the King's Fund has not commissioned a study and does not have an opinion on the cost). A proper study would have been perfect. The methodology of it could help me make an assessment. I am left to search for studies myself.

The emboldened is a risky claim to make. Do you have a citation for the number of people falling ill and dying from not having access to medicine? If it's negligible the statement does not hold. Access to medicine would already exist and there would be marginal cost without a marginal benefit. Therefore, the bill would be rest on the ideological desire to see prescriptions free, not the desire to ensure access to healthcare.
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Saracen's Fez
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(Original post by Miss Maddie)
Thank you for repeating the notes to me. I have always struggled reading them!

The question remains unanswered. Does it save money? He said, she said doesn't solve anything.
It's essentially unknowable, because the NHSes that offer free prescriptions don't know what their spend would be in the alternative reality where prescription charges apply.
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Miss Maddie
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(Original post by Saracen's Fez)
It's essentially unknowable, because the NHSes that offer free prescriptions don't know what their spend would be in the alternative reality where prescription charges apply.
As are a lot of numbers we use in society. Fortunately, there are mathematical ways to calculate them.
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LiberOfLondon
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Still no. Mr Speaker, this house does not have a money printer at its disposal.
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Miss Maddie
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(Original post by LiberOfLondon)
Still no. Mr Speaker, this house does not have a money printer at its disposal.
That's funny! I thought it did. You have voted to use the printer enough times.
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TheDefiniteArticle
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(Original post by Miss Maddie)
I expected more than a quote from a politician and a link to a opinion post by a political commentator (the King's Fund has not commissioned a study and does not have an opinion on the cost). A proper study would have been perfect. The methodology of it could help me make an assessment. I am left to search for studies myself.

The emboldened is a risky claim to make. Do you have a citation for the number of people falling ill and dying from not having access to medicine? If it's negligible the statement does not hold. Access to medicine would already exist and there would be marginal cost without a marginal benefit. Therefore, the bill would be rest on the ideological desire to see prescriptions free, not the desire to ensure access to healthcare.
What we can see is that in 2017, approximately 6% of prescriptions issued were not fulfilled: https://digital.nhs.uk/data-and-info...---2007---2017

This is approximately 66,000,000 prescription items which, despite a medical professional being of the view that it would be beneficial for the individual's, or for public health, are not fulfilled. Evidence that at least some of this relates to the cost to the patient can be derived by comparing the 6% rate above with the substantially higher rates across the pond, where we see significantly higher prescription charges on average, and a rate of unfulfilled prescriptions (depending on which study you look at) between 20-30%: http://www.ncpa.co/adherence/Adheren...tCard_Full.pdf

Even if we conservatively estimate that 1/6 of those 66m unfilled prescriptions are due to prescription charges, this seems to be an unacceptably high level to me.
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Miss Maddie
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(Original post by TheDefiniteArticle)
What we can see is that in 2017, approximately 6% of prescriptions issued were not fulfilled: https://digital.nhs.uk/data-and-info...---2007---2017

This is approximately 66,000,000 prescription items which, despite a medical professional being of the view that it would be beneficial for the individual's, or for public health, are not fulfilled. Evidence that at least some of this relates to the cost to the patient can be derived by comparing the 6% rate above with the substantially higher rates across the pond, where we see significantly higher prescription charges on average, and a rate of unfulfilled prescriptions (depending on which study you look at) between 20-30%: http://www.ncpa.co/adherence/Adheren...tCard_Full.pdf

Even if we conservatively estimate that 1/6 of those 66m unfilled prescriptions are due to prescription charges, this seems to be an unacceptably high level to me.
There are more non-adhered prescriptions in a country where the cost of them is high compared to a country where the cost is less. I could have told you that without highlighting US rates. What's you point? It doesn't tell us cost is an issue in the UK where prescriptions costs could be low enough to eliminate those concerns. It only tells us higher costs could make cost a concern for lack of fulfilment.

I can't see where you obtain 6% in the spreadsheets you linked. Until you clear that up, I will take then BMJ rate of <3%. The same rate was observed in Sweden, France, Norway and Switzerland. In France and Norway the patients will need to pay at least 35% of the market cost per item (up to 70% depending on the item). That would be more than the standardised £9.15 in England and the £105.90 for a year's worth of unlimited free prescriptions (if you're poor in England they are already free).

The article does admit to there being a correlation between charging for medicine and non-adherence. Crucially, the non-adherence rates only become higher when the cost of medicine is a lot higher. When non-adherence is below 3% I don't regard it as a major issue worth spending money to fix. Access to medication exists. The correlation ignores poor people in England already receiving free prescriptions.
Last edited by Miss Maddie; 1 week ago
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Saracen's Fez
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(Original post by Miss Maddie)
As are a lot of numbers we use in society. Fortunately, there are mathematical ways to calculate them.
Well, if you want a calculation that does 'we dispense x number of prescriptions at y amount, that makes x times y', that's my understanding of the King's Find estimate. If you want a government that has already abolished prescription charges comparing what it spent on prescriptions before and after abolishing the charge and realising that it has spent less in real terms, use the Welsh Government estimate.
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Miss Maddie
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(Original post by Saracen's Fez)
Well, if you want a calculation that does 'we dispense x number of prescriptions at y amount, that makes x times y', that's my understanding of the King's Find estimate. If you want a government that has already abolished prescription charges comparing what it spent on prescriptions before and after abolishing the charge and realising that it has spent less in real terms, use the Welsh Government estimate.
I'm confused by the Welsh Government estimate. The same minister said the cost of free prescriptions was £3m higher in 2017 than the cost of partially free ones in 2007. The government can't save money and pay £3m.
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TheDefiniteArticle
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(Original post by Miss Maddie)
There are more non-adhered prescriptions in a country where the cost of them is high compared to a country where the cost is less. I could have told you that without highlighting US rates. What's you point? It doesn't tell us cost is an issue in the UK where prescriptions costs could be low enough to eliminate those concerns. It only tells us higher costs could make cost a concern for lack of fulfilment.

I can't see where you obtain 6% in the spreadsheets you linked. Until you clear that up, I will take then BMJ rate of <3%. The same rate was observed in Sweden, France, Norway and Switzerland. In France and Norway the patients will need to pay at least 35% of the market cost per item (up to 70% depending on the item). That would be more than the standardised £9.15 in England and the £105.90 for a year's worth of unlimited free prescriptions (if you're poor in England they are already free).

The article does admit to there being a correlation between charging for medicine and non-adherence. Crucially, the non-adherence rates only become higher when the cost of medicine is a lot higher. When non-adherence is below 3% I don't regard it as a major issue worth spending money to fix. Access to medication exists. The correlation ignores poor people in England already receiving free prescriptions.
It is a trivial principle of behavioural economics that the biggest marginal change in demand comes between a price of nil and a price of 1 (of whatever unit you choose). For this reason, once it is established that demand for prescriptions is not completely inelastic, it follows that there will be a substantial difference between fulfilment of cheap prescriptions and fulfilment of free prescriptions.

The data from the linked spreadsheet is the difference between the overall percent prescribed and the overall percent dispensed from table A7. The distinction from the BMJ data - which is more useful since it is more specific - is that the BMJ data relates specifically to the number of prescriptions which are not fulfilled because of cost (hence cost-related non-adherence). The fact that this is as high as 3% means that the volume of unfulfilled prescriptions is approximately three times the conservative estimate based on a 1% distinction estimated in my post above.
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Saracen's Fez
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(Original post by Miss Maddie)
I'm confused by the Welsh Government estimate. The same minister said the cost of free prescriptions was £3m higher in 2017 than the cost of partially free ones in 2007. The government can't save money and pay £3m.
I presume he means the cost is lower in real terms. Given the size of the total bill that certainly seems plausible to me.
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