The Department of Health and Social Care has made regulations to update the NHS help with health costs framework in England, made on 5 November 2025, laid on 6 November and commencing on 1 December 2025. The instrument corrects earlier drafting in S.I. 2024/456 and S.I. 2025/636 and aligns repayment calculations for Prescription Prepayment Certificates (PPCs) with current prices.
People evacuated to the UK for medical reasons from a conflict zone can be granted time‑limited membership of the NHS Low Income Scheme at the Secretary of State’s discretion. Eligibility requires that evacuation was primarily for treatment (for the patient or an accompanying person) and that any Immigration Health Charge is exempted or has been waived or refunded. Membership confers entitlement to full remission of NHS charges and reimbursement of travel costs for NHS care.
The same cohort is added to eye‑care entitlements. Evacuated patients will be eligible for free NHS sight tests under the Primary Ophthalmic Services Regulations 2008 and optical vouchers under the National Health Service (Optical Charges and Payments) Regulations 2013, bringing them into the standard help‑with‑costs offer administered in England.
Tuberculosis medicines will be supplied free of charge under the Prescription Charges Regulations 2015 through a new provision alongside existing vaccination exemptions. Supply may be made under a patient group direction or on an NHS prescription endorsed with the ‘FS’ free‑supply indicator used in NHS dispensing systems.
For prescribers and pharmacy teams, the operational signal is familiar: select the FS flag in EPS for qualifying items or endorse ‘FS’ on paper forms; pharmacy staff should ensure no charge is taken for correctly endorsed items. This mirrors existing free‑supply processes used in specific programmes, including clinical trial waivers.
The regulations also fix the automated cancellation and refund pathway for PPCs when a patient becomes entitled to certain exemptions. S.I. 2025/636 created automatic refunds when a maternity or medical exemption certificate is issued; the new instrument closes an omission so that people undergoing treatment for, or related to, cancer are included within the automatic process.
Refund calculations for PPCs are updated so they mirror the current purchase prices: £32.05 for a three‑month PPC and £114.50 for a 12‑month PPC. These values were set from 1 May 2024 and are maintained in current DHSC guidance and NHSBSA materials.
Scope remains consistent with related charging instruments: the regulations extend to England and Wales but apply only to England. Providers should implement changes from 1 December 2025 and ensure local claims, remission and travel‑cost reimbursement processes recognise the new evacuee route to entitlement.
Eye‑care contractors should accept sight‑test eligibility and voucher claims from evacuees for the period specified by the Secretary of State, in line with the amended ophthalmic and optical regulations. Commissioning teams should brief providers and update practice guidance ahead of commencement.
Patients affected by the changes should see straightforward access: TB medicines issued on FS‑endorsed prescriptions will be free of charge, and PPC holders who become newly exempt will have certificates cancelled and refunds processed automatically according to regulation 17. Public‑facing information on PPC pricing and entitlement remains available via GOV.UK and NHSBSA.