England: TB prescriptions free from 1 Dec; evacuee help
From 1 December 2025, three practical changes to help with health costs take effect in England. TB medicines become free of the NHS prescription charge when correctly endorsed, people medically evacuated from conflict zones can be added to the NHS Low Income Scheme for a set period, and the refund rules for Prescription Prepayment Certificates (PPCs) are fixed and updated to match current prices. These updates are set out in the National Health Service (Help with Health Costs) (Miscellaneous Amendments) Regulations 2025, made on 5 November and laid before Parliament on 6 November 2025.
If you are being treated for tuberculosis, you should no longer be asked to pay the £9.90 prescription charge for TB medicines. The change covers drugs for TB itself, for complications arising from TB, and for managing side‑effects of TB treatment. The exemption applies when supply is made under a patient group direction, or when your prescriber adds the ‘FS’ endorsement to your prescription so the pharmacy knows it is a free supply.
Here is how that looks in real life. On paper FP10s, a prescriber writes ‘FS’ next to the relevant item; in electronic prescribing, an FS flag appears in the endorsement field. If you are still charged in error, ask the pharmacy for an FP57 receipt at the time you pay so you can claim a refund within three months. This is standard NHSBSA practice and protects you from penalties while the claim is checked.
The Regulations also create a clear route for people brought to the UK as part of medical evacuation arrangements from a conflict zone. If the evacuation is mainly to receive treatment (for you or for someone you are accompanying), and you are exempt from the Immigration Health Charge or it has been waived or refunded, the Secretary of State can place you on the NHS Low Income Scheme for a set period, regardless of your income. During that period you can get the full HC2 help: free prescriptions and dental treatment, help with travel to NHS care, free sight tests and support with glasses or contact lenses.
To make that support work end‑to‑end, the same instrument updates eye‑care rules so evacuees covered by these arrangements are eligible both for an NHS sight test and for optical vouchers (for glasses or contact lenses). This closes a gap so that help with health costs lines up across prescriptions, travel and eye care.
If you have a PPC and later become entitled to free NHS prescriptions because you receive a maternity exemption (MatEx) or a medical exemption (MedEx), your PPC should now be cancelled automatically and refunded. A drafting slip earlier this year meant people undergoing treatment for cancer, or for the effects of cancer or cancer treatment, were not included in those automatic arrangements; the December fix puts them back in scope. Refund values are also updated so they mirror the current PPC prices: £32.05 for 3 months and £114.50 for 12 months.
What this means for you on 1 December: if you are on TB treatment, expect your items to be processed as free when correctly endorsed. If you support evacuees, be aware that NHS Low Income Scheme membership can now be granted for a defined period without a means test, unlocking free prescriptions, dental care, travel help and eye‑care support. If you bought a PPC and then became exempt, expect cancellation and a refund aligned to today’s PPC prices.
A quick classroom note for media literacy. This change arrives via a Statutory Instrument (S.I. 2025/1165). “Made” (5 November) is when the Minister signs it; “laid” (6 November) is when Parliament is formally notified; “coming into force” (1 December) is when the rules start to apply. It amends earlier NHS charging regulations, including 2024/456 (which set today’s prices) and 2025/636 (which first created the new refund system). Understanding these time‑stamps helps you trace how policy turns into everyday practice at the pharmacy counter.
Two final reminders to keep you out of trouble. First, all of this applies in England only; arrangements differ in Scotland, Wales and Northern Ireland. Second, if you’re unsure whether you’re entitled to free prescriptions, use the NHSBSA eligibility checker or pay and keep an FP57 so you can claim back later-this avoids penalty charges.
If you teach health or social policy, this is a neat case study. Ask students to map the beneficiaries (TB patients, medical evacuees, PPC holders who become exempt) and then spot the mechanisms that make the policy work at ground level: prescriber endorsements (FS), HC2 certificates, and automatic PPC refunds. It’s a clear example of how small regulatory edits can remove real‑world barriers to care.