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SECTION 5: SUMMARY OF CHANGE POSSIBILITIES AND VIEWS SOUGHT
1 REVIEW OF EXEMPTIONS RELATED TO MEDICAL CONDITIONS
CP 1: Review the criteria by which chronic conditions are defined and consider the therapeutic categories of drugs that are essential to their treatment, where that consideration is carried out by an expert group.
CP 2: Link exemption to the drug and not the condition.
CP 3: Convert the medical exemption category to a 'high prescription user' category.
Views are sought on:
1. Whether exemption from all charges should continue to be given on medical grounds alone, and if so, whether the list of conditions should be reviewed.
2. Whether, where exemption is given on medical grounds, that exemption should relate only to drugs for the treatment of the medical condition in question, rather than (as at present) covering all drugs whether or not they relate to the condition that gives rise to the exemption.
3. Whether it makes more sense to provide exemption based on a list of drugs, or based on a list of conditions.
2 ECONOMIC NEED - AFFORDABILITY
Exemptions on Income Grounds
CP 4: Extend exemption from paying prescription charges to all persons holding a LIS HC3 certificate - which would extend charge exemption in Scotland to over 21,500 people and their dependants.
Pre-payment certificate scheme
CP 5 - issue a PPC retrospectively to patients whose prescription charges over a set period amount to the value of a PPC, ( i.e. based on current charges, once 5 prescriptions have been charged in a 4-month period) or to offset the cost of the PPC by the amount paid over a preceding set period.
CP 6 - restructure the minimum period for which the PPC applies.
Views are sought on:
1. Whether prescription charge exemption should be extended to HC3 holders.
2. What changes to the PPC system would address current barriers to its use, particularly by those on low income, and maximise patients' benefit.
Capping and concessionary fees for higher users
CP 7: Introduce a monthly charge cap with the limit set in line with the current cost of pre-payment certificate but with a more affordable entry point.
CP 8: Introduction of a concessionary rate for those patients who require regular repeat prescriptions or acute prescriptions frequently - either with or without some form of capping.
Flat Fee
CP 9: Introduce a lower flat rate charge that would be payable by all, except those with low income or age exemption.
Views are sought on:
1. Whether there should be a reduced flat fee for all (with current income based exemptions) and, if so, the level at which affordability to the patient and cost to the NHS can be balanced.
2. Whether there should be a monetary cap to the charges that a patient is required to pay over a set period of time, after which prescriptions should be free within this period of time.
3. Whether there should be a concessionary rate for patients who require frequent prescriptions, and whether the concession should be triggered by the costs incurred over a set period of time.
4. Whether there are other changes in the arrangements for pre-payments or caps that are not listed above and which would maintain charge income in general for NHS Boards.
3 ABILITY TO PAY
CP 10: Extend exemption to (a) persons up to the age of 24 or (b) all persons, in full time education or training.
CP 11: Introduce concessionary charges for persons aged 19 or over in full time education or training.
CP 12: Improve system for exemption on income grounds for persons aged 19 and over in full time education or training.
Views are sought on:
1. Whether there is a case for extending the current 'full time student' threshold to cover tertiary education.
2. Whether exemption should be extended to all persons in full time education or training, regardless of their ability to pay.
3. Whether there should be concessionary charge arrangements for full time students or trainees above set age thresholds.
4. Whether there are other changes in the charging system that could remove the need for special arrangements for full time students or trainees.
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