Prescription fraud costs Wales £15m a yearBMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7274.1431/a (Published 09 December 2000) Cite this as: BMJ 2000;321:1431
Some £15m ($21m) a year in prescription charges is being lost to the NHS in Wales by patients wrongly claiming exemptions from charges.
Auditors have found that in 9% of the cases where people had claimed exemption from prescription charges they had no entitlement to do so.
The National Audit Office Wales is now urging a better follow up system for checking that the people who have claimed exemption are entitled to do so. The office also wants similar checks for entitlement to free optical and dental services.
The office said that concern has been expressed for some time that potential income from prescription charges was being lost. The NHS in Wales spends £380m a year—some 13% of its total expenditure—on drugs and appliances, whereas income from prescriptions is only about £23m a year.
Since April last year, checks have been in place at dispensing points in England and Wales that require individuals to produce evidence for the pharmacist of their entitlement to exemption from charges. When they cannot produce evidence, the pharmacist still dispenses free of charge, but marks the prescription form “evidence not seen.”
The report identified two problems with this system. Firstly, it said, some pharmacists may not be carrying out the point-of-dispensing checks as carefully as required. Secondly, arrangements to follow up the point-of-dispensing checks when a patient has not produced any evidence are inadequate.
In its investigation, based on a sample of 2000 prescription forms, the office found that in 9% of cases where free prescriptions had been obtained, there was no entitlement. In an additional 5% of cases, exemption was classed as uncertain. If the uncertain cases were ineligible, the office says the lost income would total £30m, some £7m more than the current total income.
“On this basis, the National Audit Office Wales estimated that the potential income forgone as a result of allowing exemption from prescription charges to individuals who did not meet the relevant criteria, was in the order of £15m,” said the report.
The data show that the biggest proportion of invalid applications (30%) was among those entitlements that were related to receipt of benefits.
The office said that point-of-dispensing checks were being introduced in Wales for dentistry and optical services in the new year and that follow up checks will be needed there too.
“Clearly it is essential that individuals who are entitled to exemption from prescription charges are able to get the medicines they need dispensed free of charge. Similarly the checks that are put in place at the point of dispensing must pay due regard to pharmacists' responsibilities to their patients,” said Sir John Bourn, auditor general for Wales.
He continued: “However there are weaknesses in the current arrangements, and these allow a significant number of individuals to have their prescriptions dispensed free of charge, even though they are not entitled to exemption. The Welsh Assembly must address this, particularly as it is introducing new exemption checks for dental and optical services.”
No similar audit has been carried out in England. Wales accounts for around 5% of the population of England and Wales, and if the same level of non-entitlement was found in England, the lost income could amount to around £150m.
Maximising Income From Prescription Charges can be accessed at www.agw.wales.gov.uk/