The medical exemption certificate is the strangest part of the NHS charging system. It gives free prescriptions to people with a specific set of conditions, and that set has barely moved in decades. It reflects the medicine of the era it was drawn up in rather than the medicine of today, which is why it produces results that make no sense to anyone standing at a pharmacy counter.
This page lists what actually qualifies, what does not, and what your options are if you land in the second group. It is general information about NHS charges rather than medical advice, and only a doctor can confirm whether your condition meets a category.
The Conditions That Qualify
You can get a medical exemption certificate in England if you have one of the following:
- A permanent fistula, for example a caecostomy, colostomy, laryngostomy or ileostomy, requiring 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 requiring thyroid hormone replacement
- Epilepsy requiring continuous anticonvulsive therapy
- A continuing physical disability that means you cannot go out without the help of another person
- Undergoing treatment for cancer, the effects of cancer, or the effects of cancer treatment
That is the complete list. Cancer is the most recent addition to it, and everything above that has been there since the certificate was introduced.
The Conditions That Do Not Qualify, and Surprise People
None of the following gives you a medical exemption certificate, however serious, however permanent and however expensive the medication:
- Asthma and COPD
- High blood pressure and heart disease
- Rheumatoid arthritis and other inflammatory conditions
- Depression, anxiety, bipolar disorder and schizophrenia
- Crohn's disease and ulcerative colitis, unless a permanent stoma has been formed
- Multiple sclerosis, Parkinson's disease and motor neurone disease, unless the physical disability test is met
- HIV
- Chronic kidney disease
- Coeliac disease
The logic is not clinical. Someone with an underactive thyroid taking one cheap tablet a day gets free prescriptions for life. Someone with severe asthma on three inhalers plus tablets pays for every one. The rule is the condition, not the cost, the severity or the number of items.
Two frequent misreadings. Diabetes treated by diet alone does not qualify, so a diagnosis on its own is not enough. And the physical disability category is about being unable to go out without the help of another person, which is a high bar: struggling to walk far, or using a stick, does not meet it.
How Long a Certificate Lasts
This changed recently and the change is worth knowing about.
| Certificate type | How long it runs |
|---|---|
| Cancer-related exemption | 5 years |
| All other qualifying conditions, application received on or after 16 July 2026 | 10 years |
| All other qualifying conditions, application received before 16 July 2026 | Usually 5 years |
If you already hold a certificate, it runs for the term it was issued under. The longer term applies to applications from that date onwards, so a renewal now will typically carry you ten years rather than five.
How to Apply
You cannot apply directly to the NHSBSA. It goes through your doctor.
Speak to your GP or the doctor treating you and they will give you an application form, traditionally known as the FP92A. You complete your part, the practice confirms the medical condition and signs it, and the form goes to the NHSBSA. Some practices handle the whole submission for you.
The certificate arrives by post, with a certificate number and an expiry date. Take a photograph of it. Pharmacies check electronically in most cases, but having the number on your phone settles any question at the counter.
Backdating, and What It Is Worth
The certificate is backdated to start one month before the date the NHSBSA received your application.
That month is money if you use it. Any prescription charges you paid in that window can be reclaimed, but only if you asked for an FP57 receipt form at the moment you paid. It cannot be issued afterwards, and without it there is no claim. A refund has to be claimed within three months less a day of the date of payment.
So the sequence that works is: ask for FP57s from the moment your condition is diagnosed, then apply for the certificate, then claim back what the backdating covers. The sequence that costs you money is applying first and thinking about the receipts later. Our guide to prescription refunds covers this in more detail.
Renewal Is On You
Nobody reminds you. The certificate stops on its expiry date whether or not your condition has changed, and a lapsed certificate presented at a pharmacy is treated exactly like claiming an exemption you were never entitled to.
That means the original prescription charge plus a penalty of five times the amount owed, capped at £100. It is entirely avoidable and it happens constantly, because five or ten years is long enough to forget.
Put the expiry date in your calendar with a reminder two months before, and start the renewal then rather than on the day.
Your condition has to still qualify at renewal. The cancer category in particular is about being under treatment, or dealing with the effects of cancer or its treatment. If that no longer applies, the certificate will not be renewed, and continuing to claim on the old one is what generates a penalty charge notice.
What It Covers, and What It Does Not
A medical exemption certificate covers all your NHS prescriptions, not only the medicines for the qualifying condition. Someone with an exemption for epilepsy gets their antibiotics free too.
It does not cover NHS dental charges, sight tests, glasses or travel to hospital. Those come under the NHS Low Income Scheme or the separate exemption categories, and a medical exemption certificate will not get you anywhere at the dentist.
If Your Condition Is Not on the List
You have two realistic routes, and they are not mutually exclusive.
A prepayment certificate. This caps what you spend on prescriptions regardless of your condition or income. A 12-month PPC is £114.50, which pays for itself at 12 items a year, and a 3-month PPC is £32.05, which pays for itself at four items. Anyone on regular medication for a non-qualifying condition is almost certainly better off with one. Run your numbers through the calculator to be sure.
The NHS Low Income Scheme. Means tested rather than condition based, and it covers dental, optical and travel costs as well as prescriptions. If money is tight, apply for this first, because it is free to apply for and it is worth considerably more than a PPC. Our guide to the scheme explains the assessment and the savings limits.
It is also worth checking whether you fall into one of the non-medical categories. Age 60 or over, under 16, 16 to 18 in full-time education, pregnancy or having given birth in the last 12 months, and certain benefits all give free prescriptions in their own right, and plenty of people qualify through one of those without ever needing a medical exemption certificate.
Outside England
Wales, Scotland and Northern Ireland abolished prescription charges in 2007, 2011 and 2010 respectively. There is no charge, so there is no exemption certificate and nothing to apply for. The medical exemption certificate is an England-only document, for an England-only charge.