NHS help with health costs: England rules from 1 Dec
From 1 December 2025, new NHS rules on help with health costs take effect in England. The change arrives via a Statutory Instrument made on 5 November and laid before Parliament on 6 November 2025. You’ll see practical updates on who can get support, when prescriptions are free, and how refunds work. The instrument also corrects earlier drafting errors in S.I. 2024/456 and S.I. 2025/636 and, as legislation.gov.uk notes, has been issued free of charge to known recipients of those regulations. That’s administrative housekeeping, but the outcomes for patients and carers are concrete.
Who qualifies under the new pathway? If you are part of medical evacuation arrangements from a conflict zone, the Secretary of State can place you in the NHS Low Income Scheme for a set period, regardless of your income. This is designed for people evacuated so that they, or someone they are accompanying, can receive medical treatment. To meet the definition in law, you must have been evacuated from an area with recent armed conflict for the main purpose of treatment, and your Immigration Health Surcharge must be exempted or reduced/waived/refunded under the 2015 Order. The Secretary of State must also specify your membership period, which can be extended.
What does that membership actually cover? During the specified period, you can get full help with health costs under the Low Income Scheme. That means you do not pay NHS prescription charges or NHS dental charges that would otherwise apply, and you can be reimbursed for necessary travel when attending NHS care. This sits within the long‑running rules on “travel expenses and remission of charges”. Because two other sets of regulations are updated at the same time, you are also eligible for a free NHS sight test and for optical vouchers to help with the cost of glasses or contact lenses. The legislation makes this clear by amending the Primary Ophthalmic Services Regulations 2008 and the Optical Charges and Payments Regulations 2013.
What changes on prescriptions for tuberculosis? From 1 December, any drug supplied as part of NHS treatment for tuberculosis, the effects of tuberculosis, or the effects of tuberculosis treatment will be free of the NHS prescription charge in England. This is a new, explicit entitlement placed into the prescription charging regulations. In practical terms, the supply must be made under a patient group direction or be written on an NHS prescription where the prescriber includes the reference “FS”. That “FS” marking tells the pharmacy team the item is a free supply under the rules.
If you or someone you teach is learning how prescriptions are coded, it’s helpful to know how this works in the real world. You shouldn’t have to ask for “FS” yourself; the prescriber adds it when the medicine is for TB treatment or its effects. If treatment is given under a hospital or clinic patient group direction, there may be no paper form at all-the item is supplied without a patient charge because the direction authorises it.
There’s also a fix to the way prescription prepayment certificates (PPCs) are refunded. Earlier in 2025, regulations created an automatic cancellation/refund if you bought a PPC and then became entitled to a maternity exemption or a medical exemption. People undergoing treatment for, or related to, cancer were unintentionally left out of that automatic arrangement. The new instrument corrects this, bringing cancer treatment in line so you are not left out of pocket.
Refund amounts are updated to mirror today’s PPC prices. The refundable value for a 3‑month PPC is now £32.05 (previously £31.25). For a 12‑month PPC, it’s £114.50 (previously £111.60). These figures align the refund schedule with the current purchase costs set in earlier regulations, so the amounts match what you actually paid.
If you think you fall within the medical evacuation route, your membership of the NHS Low Income Scheme is determined by the Secretary of State for a specified period. You’ll be told if you are covered and for how long. Keep any documents you are given and bring them to appointments; NHS teams and partner agencies use them to confirm your entitlement during that period.
If you’re being treated for TB, ask your prescriber or clinic to confirm that your prescription will be marked “FS” or supplied under the service’s patient group direction. At the pharmacy counter, this should mean no prescription charge is collected for those TB medicines. If a charge is asked for in error, query it with the prescriber or pharmacy team and refer to the regulations published on legislation.gov.uk.
For PPC refunds, the process is handled by the NHS Business Services Authority (NHSBSA). If you bought a PPC and then became entitled to a maternity exemption, a medical exemption, or you are undergoing treatment for or related to cancer, you can now rely on the corrected rules for cancellation and refund. Keep your dates and documents to hand so the team can match your entitlement to your PPC purchase period.
A quick geography and timing check helps with media literacy. These regulations extend to England and Wales but apply only in England, and they start on 1 December 2025. They were made on 5 November and laid on 6 November 2025. Always look for those dates in official texts-the effective date is what determines when you can rely on a change.
What this means for you and your students: if you’re supporting someone evacuated for medical treatment, the NHS Low Income Scheme can be switched on for them for a set time so costs don’t block access to care. If you’re teaching public policy, this is a neat example of how a Statutory Instrument can both correct earlier drafting and make targeted changes that remove specific cost barriers without rewriting the whole system. The source text is on legislation.gov.uk, which is where you should verify details and wording if in doubt.