The Department of Health and Social Care has made the National Health Service (Help with Health Costs) (Miscellaneous Amendments) Regulations 2025. Signed by Minister of State Karin Smyth, the instrument was made on 5 November 2025, laid before Parliament on 6 November 2025 and comes into force on 1 December 2025. It corrects drafting issues in S.I. 2024/456 and S.I. 2025/636 and is being issued free of charge to all known recipients of those instruments, according to legislation.gov.uk (S.I. 2025/1165).
The regulations amend four existing schemes governing NHS charges and exemptions in England: the National Health Service (Travel Expenses and Remission of Charges) Regulations 2003, the Primary Ophthalmic Services Regulations 2008, the National Health Service (Optical Charges and Payments) Regulations 2013, and the National Health Service (Charges for Drugs and Appliances) Regulations 2015. They extend to England and Wales but apply only to England, as permitted under the National Health Service Act 2006.
A new regulation 13C is inserted into the Prescription Charges Regulations 2015 to remove charges for the supply or administration of any drug used to treat tuberculosis, the effects of tuberculosis, or the effects of tuberculosis treatment. This mirrors the approach already taken for coronavirus and influenza vaccinations under regulation 13B and closes gaps where TB medicines dispensed in primary care could attract a charge.
The exemption for TB medicines applies when supply is made under a patient group direction or when a prescription is issued and the prescriber marks the form with the reference “FS”. Pharmacy contractors should expect TB items that meet these criteria to be processed as charge‑free from 1 December 2025. Prescribers will need to ensure the “FS” reference is present where applicable so that remuneration and reimbursement flow correctly through existing NHS Business Services Authority processes.
Entitlement rules are widened for people evacuated to the United Kingdom for medical reasons from areas affected by armed conflict. The Travel Expenses and Remission of Charges Regulations 2003 now treat a person as eligible for full remission and payment if they are part of medical evacuation arrangements from a conflict zone and the Secretary of State has determined they are to benefit from membership of the NHS Low Income Scheme for a specified period. The determination can be extended and applies regardless of personal resources during the specified period.
The definition of a qualifying evacuee includes those exempt from the Immigration Health Surcharge under article 7 and Schedule 2 of the Immigration (Health Charge) Order 2015, or those for whom the Secretary of State has exercised discretion to reduce, waive or refund the charge under article 8. While the Low Income Scheme membership remains in force, eligible evacuees can receive full remission of NHS prescription and dental charges and reimbursement of certain travel expenses associated with NHS care.
For ophthalmic care, the Primary Ophthalmic Services Regulations 2008 are amended so that evacuees who meet the same definition become eligible for an NHS‑funded sight test. The Optical Charges and Payments Regulations 2013 are also amended to confirm that such evacuees qualify for optical vouchers for the supply, replacement or repair of optical appliances. These changes ensure consistent help with health costs across prescribing, dentistry, travel and community eye care.
The instrument also corrects the automatic cancellation and refund framework for Prescription Prepayment Certificates introduced by S.I. 2025/636. That earlier instrument enabled automatic refunds where a person subsequently became entitled to a maternity or medical exemption certificate; however, people undergoing treatment for, or related to, cancer were inadvertently omitted. The new amendments bring those patients within the same automatic cancellation and refund arrangements.
Refund amounts for prepayment certificates are updated to align with the current purchase prices set in S.I. 2024/456. Regulation 17 of the Prescription Charges Regulations is amended so that pro‑rata refunds are calculated using £32.05 for a 3‑month certificate and £114.50 for a 12‑month certificate, replacing the previous figures of £31.25 and £111.60. This ensures refund values mirror the cost patients actually paid.
Operationally, NHS prescribers, pharmacy teams, dental providers and optical contractors should ensure their procedures and patient communications reflect the new entitlements from 1 December 2025. Providers should recognise “FS” markings for TB prescriptions, confirm Low Income Scheme determinations for eligible evacuees, and apply the revised prepayment certificate refund amounts in accordance with regulation 17. Scheme details remain available from the NHS Business Services Authority at www.nhsbsa.nhs.uk/nhs-low-income-scheme.
According to the Explanatory Note on legislation.gov.uk, no full impact assessment has been produced because the instrument is not expected to have a significant effect on the private or voluntary sectors and has only a limited impact on the public sector. The amendments primarily codify exemptions, correct previous drafting, and provide a clear legal route for temporary support to medically evacuated individuals. The changes take effect in England on 1 December 2025.