The Department of Health and Social Care has made the National Health Service (Help with Health Costs) (Miscellaneous Amendments) Regulations 2025 (S.I. 2025/1165). Made on 5 November and laid on 6 November, the instrument takes effect on 1 December 2025 in England. It corrects errors in S.I. 2024/456 and S.I. 2025/636 and updates entitlements under the NHS charging and remission framework.
The Regulations extend to England and Wales but apply only to England. The instrument is being issued without charge to known recipients of the earlier instruments it corrects, according to the legislation notice.
A new provision supports people arriving under medical evacuation arrangements from conflict zones. Where a person has been evacuated primarily to receive medical treatment (or to accompany someone for treatment), is exempt from or has had the Immigration Health Surcharge waived or refunded, and the Secretary of State specifies an eligibility period, they may be granted time‑limited membership of the NHS Low Income Scheme irrespective of means. The period can be extended.
Consequential amendments ensure those evacuees are also eligible for an NHS sight test and optical vouchers. This is achieved by changes to the Primary Ophthalmic Services Regulations 2008 and the Optical Charges and Payments Regulations 2013 that mirror the new definition used for Low Income Scheme membership.
Prescription charges for tuberculosis are removed. A new regulation 13C to the 2015 Prescription Charges Regulations provides that no charge is payable for drugs to treat TB, its effects or the effects of its treatment. The rule applies when medicines are supplied under a patient group direction, or when a prescriber includes the ‘FS’ (free supply) endorsement on a prescription.
Prescribers and dispensers should handle the FS endorsement using established processes. In EPS, FS must be selected as a structured flag rather than typed into dosage fields; on paper FP10s, FS should be written and signed next to each relevant item. Paper prescriptions with FS items should go in the red separator, and mixed scripts should be avoided to prevent charge errors.
On pre‑payment certificates (PPCs), S.I. 2025/636 introduced automatic cancellation and refunds when a patient becomes entitled to a maternity or medical exemption certificate. The Explanatory Note to S.I. 2025/1165 states that people undergoing treatment for, or related to, cancer were inadvertently omitted from those automatic arrangements and are now included.
Refund values are revised so repayments mirror current PPC prices-£32.05 (three months) and £114.50 (twelve months)-aligning regulation 17 with the uplift made by S.I. 2024/456 and the amounts currently published by government. Providers and NHSBSA should ensure back‑office refund logic uses these figures.
Operationally, the changes are narrow but immediate from 1 December. Providers should confirm TB PGDs cover intended supply routes in primary care, ensure prescribing systems support FS for TB where clinically appropriate, and brief pharmacy teams to follow correct reimbursement steps so no charges are deducted in error. NHSBSA and local teams should be ready to process Low Income Scheme determinations for evacuees issued by the Secretary of State.
For patients the effect is clear. TB medicines issued via a PGD or with the FS endorsement will be free at the point of supply. Evacuees granted Low Income Scheme membership will be eligible for prescription and dental charge remission and travel cost reimbursement, and-through linked amendments-will be entitled to an NHS sight test and optical vouchers.
Devolution is unchanged: the instrument applies only in England and prescription charging policy remains devolved. Government guidance confirms PPC prices at £32.05 and £114.50, and reiterates that NHS prescription charges apply in England only.
The timing aligns with wider government work to support medical evacuations from conflict zones, including assistance for critically ill patients from Gaza and participation by Wales in the UK scheme. Providers receiving evacuees should expect cross‑government coordination as cases are routed into NHS services.