Medical Exemption Certificate – are you in date?

People with a permanent fistula or one of the medical conditions listed overleaf, living in England and receiving exemption to prescription charges, for which payment would otherwise have to be made, are urged to check that their exemption certificate is in date. The Prescription Pricing Authority (PPA) is issuing penalty fines to those claiming exemption without a valid certificate, regardless of having a condition that qualifies.

Entitlement must be authorised by a GP. It is the patient’s responsibility to ensure that the certificate is renewed on time. Reminder notices are issued 3-4 weeks prior to expiry of the current certificate to the last known address. Any changes in address need to be notified directly to the PPA by the person seeking exemption otherwise timely reminders will not be received. At the time of going to press, it is not possible to claim online as the form requires a GP signature.

The process of renewing exemption certificates changed in 2013 and now requires a GP signature for both new applications and renewals. The form is FP92A.

If a certificate has expired, or is due to expire, and is in the process of being renewed, it is recommended that an NHS Prescription Refund form, FP57, is obtained for any prescriptions for which payment is made. This needs to be obtained at the time of payment. When the application is processed by PPA, it can be backdated up to ONE MONTH from date of receipt. When the card is received, prescription costs for which receipts are available can be claimed from the pharmacy on provision of the NHS Prescription Refund form FP57 and valid exemption certificate for up to three months from the date of the charge. The date on the refund form must be after the start date of the certificate, otherwise a refund cannot be claimed.

Further information about medical exemption can be obtained from the PPA website at or you can contact the PPA helpdesk on 0300 330 1341.

The following conditions are on the exemption list:

  • a permanent fistula (for example, caecostomy, colostomy, laryngostomy or ileostomy) which needs continuous surgical dressing or an appliance;
  • a form of hypoadrenalism (for example, Addison’s Disease) for which specific substitution therapy is essential;
  • diabetes insipidus and other forms of hypopituitarism;
  • diabetes mellitus, except where treatment is by diet alone;
  • hypoparathyroidism;
  • myasthenia gravis;
  • myxoedema (that is, hypothyroidism which needs thyroid hormone replacement);
  • epilepsy which needs continuous anticonvulsive therapy;
  • a continuing physical disability which means you cannot go out without the help of another person; or
  • cancer and are undergoing treatment for:
    • cancer;
    • the effects of cancer; or,
    • the effects of cancer treatment.

You can only get a certificate if you have a condition on the list. If you are not sure about the name of your condition, check with your doctor. Doctors may advise you about free prescriptions. However, it is up to you to find out if you are entitled to an exemption certificate.

Please note that you only need an exemption certificate if you would normally have to pay for your prescriptions.

You can get free NHS prescriptions if, at the time the prescription is dispensed, you:

  • are 60 or over
  • are under 16
  • are 16-18 and in full-time education
  • are pregnant or have had a baby in the previous 12 months and have a valid maternity exemption certificate (MatEx)
  • have a specified medical condition and have a valid medical exemption certificate (MedEx)
  • have a continuing physical disability that prevents you from going out without help from another person and have a valid MedEx
  • hold a valid war pension exemption certificate and the prescription is for your accepted disability
  • are an NHS inpatient
  • in receipt of certain state benefits