2018/19 to 2025/26

Published 25 June 2026

Key findings 2025/26

Background

The NHSBSA administers a range of services to help people with their health costs, including help with:

  • NHS prescription costs
  • NHS dental costs
  • sight tests, glasses and contact lenses
  • travel to receive NHS treatment
  • NHS wigs and fabric supports

Full details of these schemes are available on the NHS Help with Health Costs webpage.

Five main certificate schemes are available, with different levels of help with health costs:

The NHS Tax Credit exemption certificate scheme is no longer issuing certificates, so analysis of this scheme is not included in this release. Data on the Tax Credit exemption certificate scheme is available in the previous 2024/25 release of this publication series.

Maternity exemption certificates

The number of certificates issued has risen each year since 2020/21. There were 584,000 maternity exemption certificates issued in 2025/26.

Generally, less deprived areas of the country received fewer maternity exemption certificates than more deprived areas. The number of certificates issued was highest in 30-34 year olds, accounting for 36% of all certificates issued.

Medical exemption certificates

In 2025/26 the number of medical exemption certificates issued decreased for the first time since 2020/21, down to 436,000 medical certificates. Medical exemption certificates are normally valid for 5 years, so the reduced number of certificates issued in 2020/21 may be contributing to fewer renewals 5 years later in 2025/26.

The number of certificates issued increases with age.

NHS Low Income Scheme

The total number of certificates issued in 2025/26 increased to 259,000. The total number of HC2 certificates increased to 162,000, while HC3 certificates increased to 97,000.

Certificates were most commonly issued to people from the youngest age groups of 15-19 and 20-24, and the oldest age group of 65+. More certificates were issued to people from more deprived areas.

NHS Prescription Prepayment Certificate (PPC)

The total number of PPCs purchased has increased every year since 2020/21. There were 2.2 million 12-month certificates issued and 1 million 3-month certificates issued in 2025/26.

The number of PPCs issued increases in older age groups for both 12-month and 3-month certificate durations. There is no clear pattern by deprivation in England, with the number of 12-month certificates issued in the most and least deprived areas slightly lower than in other areas.

NHS Hormone Replacement Therapy Prescription Prepayment Certificate (HRT PPC)

The HRT PPC was introduced on 1 April 2023. There were 572,000 HRT PPCs issued in 2025/26, an increase from 2024/25. Increases were not consistent across the year, with April 2025 to July 2025 having fewer certificates in the same months in the previous year. From August 2025 to March 2026 the number of certificates issued each month was higher than in the same month in the previous year.

The number of certificates issued was higher in less deprived areas.

Integrated Care Boards (ICBs) in the South and South West regions of England generally have higher rates of HRT PPCs issued.

1. Things you should know

The data used to produce this summary narrative is available as data downloads for each figure. The data is also available in the supporting summary tables on the HWHC 2025/26 release webpage. A data dashboard has been produced to allow users to explore the data in more detail.

More information on what the data in this publication covers can be found in the background and methodology document.

1.1. Data quality

These statistics are based on information from applications and data captured during certificate processing activities. Therefore, where information has not been supplied or captured accurately, this may impact the quality of the statistics. The NHSBSA takes measures to minimise potential errors including monthly quality checks based on a random sample of certificates issued. As of May 2024, the 12-month rolling accuracy results for NHS Help with Health Costs service areas were above 98%.

1.2. Caveats

Data in this publication may differ from other sources due to differences in how certificates are assigned to an issue year or issue month. It is possible for small differences in data to happen if the underlying data is extracted on different dates.

Figures are presented based on the number of applications and issued certificates. Figures should not be interpreted as numbers of people as a unique individual could be represented multiple times.

1.3. Time periods

These statistics provide estimates of volumes related to the 5 certificate schemes. Data covers the financial years 2018/2019 to 2025/26, where the financial year runs from 1 April to 31 March.

The time period covered by these statistics includes the Coronavirus (COVID-19) pandemic period. It is worth noting that during this time period there was a reduction in face-to-face primary care consultations, referrals, new prescriptions and diagnoses due to the COVID-19 pandemic and national lockdowns.

1.4. Location

The NHS Low Income Scheme provides support to people in England, but also to some applicants from Scotland and Wales. The other NHS Help with Health Costs services administered by the NHSBSA are typically focused on support for residents in England. Within this report, figures represent all activity, with additional breakdowns by country available in the supporting datasets.

Integrated Care Board (ICB) areas have been used within this narrative to allow comparisons between areas. The ICB organisational structure changed in April 2026, but this release uses the ICB 2023 structure which was in place during the time period covered by the data. Applicants are aligned to an ICB area based on their postcode and mappings available using the National Statistics Postcode Lookup (NSPL) - February 2026.

1.5. Purpose

This publication can have a wide range of uses, including:

  • informing government or local NHS policy
  • monitoring the uptake of NHS Help with Health Costs schemes, including by ICB and by Index of Multiple Deprivation (IMD) quintiles
  • allowing scrutiny by the public and stakeholders

2. Results and commentary

2.1. Maternity exemption certificate

Maternity exemption certificates exempt the holders from NHS prescription charges. They can also be used as proof of entitlement to free NHS dental treatment whilst pregnant.

Maternity exemption certificates are available to anybody who is currently pregnant or has given birth in the last 12 months. The certificate is valid until 12 months from the baby’s due date or the birth of the baby.

Applications are submitted via a midwife, doctor or health visitor who confirms eligibility. Both paper and digital applications are available.

Only a small proportion of applications would not end with a certificate being issued. Certificates may not be issued if essential details cannot be confirmed by the applicant or other issues cannot be resolved. Due to the time taken to resolve an application, some certificates may be issued in a later time period to when the application was submitted.

As a maternity exemption certificate provides support with NHS prescription charges, support is generally applicable to applicants from England only.

Number of maternity exemption certificates issued 2018/19 to 2025/26

There were 584,000 certificates issued in 2025/26.

Issued certificates increased by almost 2% since 2024/25.

Chart
Figure 1: The number of certificates issued has increased each year since 2020/21

Number of maternity exemption certificates issued from 2018/19 to 2025/26

Table
Table 1: The number of certificates issued has increased each year since 2020/21

Number of maternity exemption certificates issued from 2018/19 to 2025/26

Financial year Number of certificates issued
2018/2019 478,585
2019/2020 477,533
2020/2021 445,501
2021/2022 457,839
2022/2023 494,079
2023/2024 551,682
2024/2025 573,715
2025/2026 584,480

The number of maternity exemption certificates issued decreased in 2020/2021 but has increased in each of the following years. In 2025/26 there were 584,000 maternity exemption certificates issued, 1.9% more than the 574,000 certificates issued in 2024/25. This was a smaller percentage change than the 4% increase between 2023/24 and 2024/25.

Number of maternity exemption certificates issued, split by age band of applicant 2025/26

Numbers are highest in the 30-34 age band, with 211,000 certificates issued to this age group.

Distribution of issued certificates by age follows a similar pattern to live birth statistics.

Chart
Figure 2: Certificates issued were highest in the 30-34 age group

Number of maternity exemption certificates issued in 2025/26 by age of applicant

Supporting Information (Live Births)
Figure 2 (supporting information): Live births are highest in the 30-34 age group

Number of live births in 2025, by age of mother

Source: 2025 Live birth figures from the Office for National Statistics

Table
Table 2: Certificates issued were highest in the 30-34 age group

Number of maternity exemption certificates issued in 2025/26 by age of applicant

Note: In Table 2, ONS live births data for under 20s are included alongside the 15-19 age band for certificates issued. However, the under 20 age band in the ONS lives births data will include live births for those aged under 15.

Age band Number of certificates issued ONS live births (2025)
15-19 11,276 11,473
20-24 60,205 60,127
25-29 150,316 139,324
30-34 211,231 196,804
35-39 122,151 121,131
40-44 26,675 27,334
45+ 2,610 2,725

The distribution of maternity exemption certificates by age is highest at 30-34, with 211,000 certificates issued to this age group in 2025/26.

There is no publicly available data that accurately shows the number of women eligible for maternity exemptions in a specific time period. However, the age distribution is very similar to the latest available live birth statistics published by the Office for National Statistics (ONS) for 2025. The live births data does not cover the same time period as the 2025/26 financial year of the certificates issued, and is included for context only.

Number of maternity exemption certificates issued, split by Index of Multiple Deprivation (IMD) quintile 2025/26

Chart
Figure 3: The number of certificates issued was lowest in the least deprived areas

Number of maternity exemption certificates issued in 2025/26 by IMD quintile of recipient

Supporting Information (Live Births)
Figure 3 (supporting information): The number of live births decreases as deprivation decreases

Number of live births in 2025, by IMD quintile of mother

Source: 2025 Live birth figures from the Office for National Statistics

Table
Table 3: The number of certificates issued is lowest in the least deprived areas

Number of maternity exemption certificates issued in 2025/26 by IMD quintile of recipient

IMD quintile Number of certificates issued ONS live births (2025)
1 135,874 144,332
2 127,824 120,560
3 114,819 106,991
4 109,290 101,240
5 93,428 85,865

The English Indices of Deprivation provide a measure of deprivation. You can find more information on the English Indices of Deprivation in section 3 of this summary.

The number of certificates issued is generally lower in less deprived areas, with the least deprived areas having the fewest number of certificates issued. The number of certificates issued decreases as deprivation decreases, which is a a similar pattern across quintiles to the latest available live birth statistics published by the ONS. In the most deprived areas, women may be more likely to qualify for other income-related benefits that offer the same support as a maternity exemption certificate.

Number of maternity exemption certificates issued per 10,000 population, by ICB 2025/26

Map
Figure 4 (map): Certificates issued per 10,000 population varies by ICB area

Number of maternity exemption certificates issued in 2025/26 ICB areas, per 10,000 female population aged 15 to 45

Chart
Figure 4 (chart): Certificates issued per 10,000 population varies by ICB area

Number of maternity exemption certificates issued in 2025/26, by ICB area, per 10,000 female population aged 15 to 45

Table
Table 4: Certificates issued per 10,000 population varies by ICB area

Number of maternity exemption certificates issued in 2025/26, by ICB area, per 10,000 female population aged 15 to 45

ICB name Number of issued certificates per 10,000 population Number of certificates issued Population:ONS mid-year estimate 2024 (females aged 15-45)
NHS Bedfordshire, Luton and Milton Keynes Integrated Care Board 600 13,382 223,147
NHS North East London Integrated Care Board 553 29,971 541,956
NHS Hertfordshire and West Essex Integrated Care Board 551 16,971 308,076
NHS Frimley Integrated Care Board 549 9,059 164,864
NHS Black Country Integrated Care Board 543 14,002 257,700
NHS Surrey Heartlands Integrated Care Board 534 11,147 208,884
NHS Mid and South Essex Integrated Care Board 531 12,857 241,957
NHS Kent and Medway Integrated Care Board 526 19,640 373,170
NHS Cambridgeshire and Peterborough Integrated Care Board 517 10,166 196,571
NHS Suffolk and North East Essex Integrated Care Board 512 9,392 183,363
NHS Birmingham and Solihull Integrated Care Board 511 16,169 316,141
NHS Northamptonshire Integrated Care Board 511 8,261 161,681
NHS Gloucestershire Integrated Care Board 508 6,260 123,125
NHS Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board 505 19,031 376,889
NHS South West London Integrated Care Board 501 18,346 366,078
NHS North West London Integrated Care Board 499 26,246 525,484
NHS West Yorkshire Integrated Care Board 494 26,096 527,806
NHS Coventry and Warwickshire Integrated Care Board 488 10,048 205,824
NHS Derby and Derbyshire Integrated Care Board 487 9,960 204,514
NHS South East London Integrated Care Board 486 22,246 457,545
NHS Shropshire, Telford and Wrekin Integrated Care Board 483 4,469 92,543
NHS Herefordshire and Worcestershire Integrated Care Board 482 6,809 141,328
NHS Greater Manchester Integrated Care Board 480 31,536 657,114
NHS Somerset Integrated Care Board 477 4,682 98,196
NHS Lancashire and South Cumbria Integrated Care Board 473 15,873 335,380
NHS Leicester, Leicestershire and Rutland Integrated Care Board 470 11,293 240,121
NHS Bristol, North Somerset and South Gloucestershire Integrated Care Board 469 10,934 233,236
NHS Hampshire and Isle of Wight Integrated Care Board 469 16,889 359,847
NHS North Central London Integrated Care Board 468 16,679 356,649
NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care Board 466 8,623 184,848
NHS Sussex Integrated Care Board 463 15,067 325,197
NHS Lincolnshire Integrated Care Board 453 6,307 139,169
NHS Staffordshire and Stoke-on-Trent Integrated Care Board 451 9,842 218,238
NHS Norfolk and Waveney Integrated Care Board 443 8,159 183,990
NHS Humber and North Yorkshire Integrated Care Board 438 13,915 317,691
NHS Nottingham and Nottinghamshire Integrated Care Board 437 10,823 247,826
NHS South Yorkshire Integrated Care Board 432 12,687 293,727
NHS North East and North Cumbria Integrated Care Board 431 25,600 594,038
NHS Cheshire and Merseyside Integrated Care Board 430 22,150 515,438
NHS Dorset Integrated Care Board 428 5,976 139,557
NHS Devon Integrated Care Board 425 9,565 225,245
NHS Cornwall and the Isles of Scilly Integrated Care Board 419 4,107 97,988

ICB areas have been used to allow comparisons between areas, with applicants aligned to an ICB area based on their postcode.

Population estimates use the 2024 mid-year population estimates by ICB published by the ONS, the latest available at time of publication. Population estimates used have been limited to the female population aged 15 to 45, to align with women who may be most likely to benefit from maternity exemption certificates. There is currently no publicly available data on the number of women who would qualify for support via the maternity exemption certificate at a point in time.

Bedfordshire, Luton and Milton Keynes ICB had the highest estimated number of certificates issued per 10,000 population in 2025/26. In this ICB an estimated 600 certificates were issued per 10,000 population.

The ICB with the lowest estimated number of certificates issued per 10,000 population in 2025/26 was Cornwall and the Isles of Scilly ICB. This ICB had an estimated 419 certificates per 10,000 population.

2.2. Medical exemption certificate

Medical exemption certificates exempt the holders from NHS prescription charges only. Patients with any of the qualifying conditions can apply for a certificate. It is the certificate that provides exemption - not the condition.

Patients can apply for a medical exemption certificate if they have either:

  • a permanent fistula (for example, caecostomy, colostomy, laryngostomy or ileostomy) which needs continuous surgical dressing or an appliance
  • a form of hypoadrenalism (for example, Addison’s Disease) for which specific substitution therapy is essential
  • diabetes insipidus and other forms of hypopituitarism
  • diabetes mellitus, except where treatment is by diet alone
  • hypoparathyroidism
  • myasthenia gravis
  • myxoedema (hypothyroidism which needs thyroid hormone replacement)
  • epilepsy which needs continuous anticonvulsive therapy
  • a continuing physical disability which means you cannot go out without the help of another person
  • cancer and are undergoing treatment for either:
    • cancer
    • the effects of cancer
    • the effects of cancer treatment

Applications are submitted via a GP or doctor who confirms eligibility. Medical exemption certificates are usually valid for 5 years. Certificates will not be automatically renewed upon expiration, with certificate holders needing to reapply.

Only a small proportion of applications would not end with a certificate being issued. Certificates may not be issued if essential details cannot be confirmed by the applicant or other issues cannot be resolved. Due to the time taken to resolve an application, some certificates may be issued in a later time period to when the application was submitted.

As a medical exemption certificate provides support with NHS prescription charges, support is only applicable to applicants from England aged between 16 and 59.

Number of medical exemption certificates issued 2018/19 to 2025/26

There were 436,000 certificates issued in 2025/26.

Certificates issued fell by almost 10% in 2025/26 after 4 years of increases.

Chart
Figure 5: The number of certificates issued fell for the first time since 2020/21

Number of medical exemption certificates issued from 2018/19 to 2025/26

Table
Table 5: The number of certificates issued fell for the first time since 2020/21

Number of medical exemption certificates issued from 2018/19 to 2025/26

Financial year Number of certificates issued
2018/2019 469,524
2019/2020 453,143
2020/2021 347,994
2021/2022 365,969
2022/2023 453,361
2023/2024 475,400
2024/2025 483,510
2025/2026 435,750

The number of issued medical exemption certificates decreased in 2025/26, after 4 years of increases between 2021/22 and 2024/25. As medical exemption certificates are valid for 5 years, the reduced number of certificates issued in 2020/21 may be contributing to fewer renewals 5 years later in 2025/26.

In 2025/26 there were 436,000 medical exemption certificates issued, a decrease of 9.9% from 484,000 in 2024/25.

Number of medical exemption certificates issued, split by age of applicant 2025/26

The number of certificates issued increases with age.

118,000 certificates were issued to people aged 55-59 in 2025/26.

Chart
Figure 6: The number of certificates issued is higher in older age bands

Number of medical exemption certificates issued in 2025/26 by age of applicant

Table
Table 6: The number of certificates issued is higher in older age bands

Number of medical exemption certificates issued in 2025/26 by age of applicant

Age band Number of certificates issued
15-19 9,520
20-24 11,992
25-29 19,512
30-34 28,037
35-39 39,268
40-44 52,239
45-49 65,984
50-54 91,201
55-59 117,931

There is a strong relationship between applicant age and medical exemption certificates, with the number of certificates issued increasing as age increases. This may be expected due to long-term conditions and multi-morbidity being more prevalent in older people. In 2025/26, the number of issued certificates in the 15-19 age group was 9,520, rising to 118,000 in the 55-59 age group.

A medical exemption certificate only entitles the holder to free NHS prescriptions. Therefore, it is not required for people aged under 16, aged 16 to 18 and in full time education, or after the age of 60. NHS prescriptions are free for these age groups.

Number of medical exemption certificates issued, split by IMD quintile 2025/26

Chart
Figure 7: Certificates are issued less frequently to people in the least deprived areas

Number of medical exemption certificates issued in 2025/26 by IMD quintile

Table
Table 7: Certificates are issued less frequently to people in the least deprived areas

Number of medical exemption certificates issued in 2025/26 by IMD quintile

IMD quintile Number of certificates issued
1 93,729
2 94,936
3 87,051
4 83,088
5 76,808

The least deprived areas had the fewest certificates issued in 2025/26. Quintile 2 had the highest number of certificates issued, with slightly more than the most deprived areas in quintile 1. There was a similar pattern across quintiles in 2024/25. In the most deprived areas people may be more likely to qualify for other income-related benefits that offer the same support as a medical exemption certificate.

Current mid-year population estimates by IMD were unavailable at time of publication.

Number of medical exemption certificates issued per 10,000 population, by ICB 2025/26

Map
Figure 8 (map): Certificates issued per 10,000 population varies by ICB area

Number of medical exemption certificates issued in 2025/26 by ICB area, per 10,000 population aged 16 to 59 receiving NHS prescriptions

Chart
Figure 8 (chart): Certificates issued per 10,000 population varies by ICB area

Number of medical exemption certificates issued in 2025/26 by ICB area, per 10,000 population aged 16 to 59 receiving NHS prescriptions

Table
Table 8: Certificates issued per 10,000 population varies by ICB area

Number of medical exemption certificates issued in 2025/26 by ICB area, per 10,000 population aged 16 to 59 receiving NHS prescriptions

ICB name Number of issued certificates per 10,000 population Number of certificates issued Population:Estimated patients (aged 16-59) receiving NHS prescribing (2025/2026)
NHS Lincolnshire Integrated Care Board 282 6,114 217,073
NHS Suffolk and North East Essex Integrated Care Board 270 8,093 299,837
NHS North West London Integrated Care Board 270 19,469 720,997
NHS Cambridgeshire and Peterborough Integrated Care Board 265 7,634 287,702
NHS Bedfordshire, Luton and Milton Keynes Integrated Care Board 264 9,296 352,411
NHS Leicester, Leicestershire and Rutland Integrated Care Board 256 9,600 374,837
NHS Northamptonshire Integrated Care Board 255 6,653 260,992
NHS Frimley Integrated Care Board 253 6,714 265,314
NHS North East London Integrated Care Board 252 18,717 742,752
NHS Shropshire, Telford and Wrekin Integrated Care Board 251 3,743 149,272
NHS Cornwall and the Isles of Scilly Integrated Care Board 249 3,832 153,972
NHS Herefordshire and Worcestershire Integrated Care Board 247 5,921 240,146
NHS Kent and Medway Integrated Care Board 246 14,561 591,166
NHS Coventry and Warwickshire Integrated Care Board 245 7,967 325,310
NHS Norfolk and Waveney Integrated Care Board 245 7,389 301,210
NHS Somerset Integrated Care Board 245 4,094 166,792
NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care Board 242 7,043 290,543
NHS Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board 241 13,537 562,109
NHS Humber and North Yorkshire Integrated Care Board 241 12,637 523,391
NHS Hertfordshire and West Essex Integrated Care Board 230 11,421 497,029
NHS Mid and South Essex Integrated Care Board 230 9,388 407,619
NHS Black Country Integrated Care Board 230 10,181 443,444
NHS Gloucestershire Integrated Care Board 229 4,690 204,834
NHS Devon Integrated Care Board 228 8,451 369,866
NHS Staffordshire and Stoke-on-Trent Integrated Care Board 227 8,713 383,011
NHS Sussex Integrated Care Board 226 12,631 559,729
NHS Hampshire and Isle of Wight Integrated Care Board 225 13,429 596,323
NHS South West London Integrated Care Board 220 11,697 530,697
NHS Derby and Derbyshire Integrated Care Board 220 8,087 368,259
NHS Surrey Heartlands Integrated Care Board 218 7,664 351,499
NHS Nottingham and Nottinghamshire Integrated Care Board 211 8,442 400,740
NHS North East and North Cumbria Integrated Care Board 210 22,029 1,049,422
NHS Dorset Integrated Care Board 209 5,050 241,218
NHS Bristol, North Somerset and South Gloucestershire Integrated Care Board 208 7,188 345,442
NHS West Yorkshire Integrated Care Board 208 18,772 902,272
NHS Birmingham and Solihull Integrated Care Board 208 10,771 518,327
NHS Lancashire and South Cumbria Integrated Care Board 207 12,343 595,367
NHS North Central London Integrated Care Board 205 10,094 492,576
NHS South East London Integrated Care Board 199 12,388 623,926
NHS South Yorkshire Integrated Care Board 199 10,187 511,246
NHS Greater Manchester Integrated Care Board 197 21,636 1,099,666
NHS Cheshire and Merseyside Integrated Care Board 191 17,346 908,678

ICB areas have been used to allow comparisons between areas, with applicants aligned to an ICB area based on their postcode.

Population estimates are based on the number of patients aged 16-59 who were identified as receiving NHS prescriptions during 2025/26. The population estimates include all patients regardless of whether or not they paid prescription charges in 2025/26. The estimates also include patients who do not qualify for support via the medical exemption certificate. These population estimates may exclude some patients who cannot be identified in the NHS prescriptions dataset, or those who cannot be assigned to an ICB or age group from the available data.

Overall, the number of certificates issued varies between ICBs. Cheshire and Merseyside ICB had the lowest number of medical exemption certificates issued per 10,000 population, at 191, while Lincolnshire ICB had the highest, at 282.

2.3. NHS Low Income Scheme

The NHS Low Income Scheme provides income related help. Support is available for people who do not receive help with health costs via an existing exemption.

NHS Low Income Scheme exemption provides help with:

  • NHS prescriptions
  • NHS dental treatment
  • sight tests, glasses and contact lenses
  • travel to receive NHS treatment
  • NHS wigs and fabric supports

Applicants either complete a paper HC1 form or apply via the online application for NHS Low Income Scheme. Two levels of support are available from the NHS Low Income Scheme. Depending on the outcome of the assessment, applicants could receive:

  • an HC2 certificate for full help with health costs, including free NHS prescriptions
  • an HC3 certificate for limited help with health costs, which will show how much the holder has to pay towards health costs

The amount of support provided is based on weekly income, necessary outgoings, plus any savings or investments. Issued certificates may also cover the applicant’s partner and dependent children under 20 years old.

The majority of certificates are issued for a year, but some are issued for periods of between 1 day and 5 years, depending on circumstances.

The majority of activity is for applicants from England, however applications are also processed for applicants from Scotland and Wales.

These statistics exclude any figures for certificates issued to asylum seekers assisted by UK Visas and Immigration (UKVI). These individuals are issued certificates automatically as part of the support they receive and are not handled through the regular application and assessment process.

Number of NHS Low Income Scheme certificates issued by certificate type from 2018/19 to 2025/26

The number of HC2 and HC3 certificates issued both increased in 2025/26.

HC3 certificates issued have increased by more than 10% since 2024/25.

Chart
Figure 9: Almost two-thirds of certificates issued in 2025/26 provided full help with health costs

Number of NHS Low Income Scheme certificates issued, by certificate type, from 2018/19 to 2025/26

Table
Table 9: Almost two-thirds of certificates issued in 2025/26 provided full help with health costs

Number of NHS Low Income Scheme certificates issued, by certificate type, from 2018/19 to 2025/26

Certificate type Financial year Number of certificates issued
HC2 2018/2019 192,452
HC2 2019/2020 172,691
HC2 2020/2021 110,055
HC2 2021/2022 150,178
HC2 2022/2023 167,242
HC2 2023/2024 161,455
HC2 2024/2025 153,877
HC2 2025/2026 162,142
HC3 2018/2019 95,351
HC3 2019/2020 90,679
HC3 2020/2021 56,941
HC3 2021/2022 69,313
HC3 2022/2023 96,666
HC3 2023/2024 87,053
HC3 2024/2025 87,934
HC3 2025/2026 96,901

In 2025/26, there were 259,000 certificates issued for the Low Income Scheme. Out of this total, 162,000 were HC2 certificates and 96,900 were HC3 certificates. Both types of certificates increased, with 5.4% more HC2 certificates and 10% more HC3 certificates issued than in 2024/25.

These figures do not include any applications that are ongoing or were abandoned before completion, as certificates are only issued to applicants once the assessment has been completed. The figures also exclude completed applications where no certificate was issued to the applicant.

Number of NHS Low Income Scheme certificates issued, split by certificate type and applicant age band in 2025/26

In 2025/26, more HC2 certificates were issued to applicants aged 65 and over than any other age group.

Applicants aged 20 to 24 were issued the most HC3 certificates in 2025/26.

Chart
Figure 10: More than half of certificates issued were to people aged under 25 or 65 and over

Number of NHS Low Income Scheme certificates issued in 2025/26, by certificate type and applicant age band

Table
Table 10: More than half of certificates issued were to people aged under 25 or 65 and over

Number of NHS Low Income Scheme certificates issued in 2025/26, by certificate type and applicant age band

Certificate type Age band Number of certificates issued
HC2 15-19 24,723
HC2 20-24 31,786
HC2 25-29 14,993
HC2 30-34 10,302
HC2 35-39 8,923
HC2 40-44 7,319
HC2 45-49 6,402
HC2 50-54 6,896
HC2 55-59 8,603
HC2 60-64 9,343
HC2 65+ 32,620
HC3 15-19 17,206
HC3 20-24 22,079
HC3 25-29 5,567
HC3 30-34 5,575
HC3 35-39 6,799
HC3 40-44 6,503
HC3 45-49 5,870
HC3 50-54 5,408
HC3 55-59 4,685
HC3 60-64 1,182
HC3 65+ 15,993

NHS Low Income Scheme certificates cover the applicant, partners and any dependent children, but age information is only captured for the lead applicant.

The total number of HC2 and HC3 certificates issued was highest in the oldest age group and 2 youngest age groups, compared to other ages. There were 48,600 certificates were issued to people aged 65 and over in 2025/26. There were 53,900 certificates issued to applicants aged 20-24 and 41,900 certificates issued to applicants aged 15-19. In 2025/26 across both certificate types, 56% of certificates issued were to applicants in these 3 age groups.

The largest age band for HC2 was applicants aged 65 and over, at 20% of the HC2 total certificates issued for 2025/26. This was different to HC3, where the largest age band in 2025/26 was applicants aged 20-24, with 23% of the HC3 total certificates issued.

Number of NHS Low Income Scheme certificates issued, split by certificate type and IMD quintile in 2025/26

In 2025/26 there were 76,100 certificates issued to people in the most deprived areas.

The number of certificates issued was higher in more deprived areas for HC2 and HC3 certificates.

Chart
Figure 11: The number of certificates issued in the most deprived areas was more than 3 times higher than the least deprived areas

Number of NHS Low Income Scheme certificates issued in 2025/26, split by certificate type and IMD quintile

Table
Table 11: The number of certificates issued in the most deprived areas was more than 3 times higher than the least deprived areas

Number of NHS Low Income Scheme certificates issued in 2025/26, split by certificate type and IMD quintile

Certificate type IMD quintile Number of certificates issued
HC2 1 45,056
HC2 2 40,973
HC2 3 30,631
HC2 4 21,345
HC2 5 14,583
HC3 1 30,996
HC3 2 23,432
HC3 3 16,348
HC3 4 12,605
HC3 5 8,826

In 2025/26, there were 76,100 certificates issued in quintile 1, the most deprived areas. This was more than 3 times higher than the least deprived areas, where 23,400 certificates were issued. The pattern across quintiles was similar between HC2 and HC3 certificates.

IMD quintiles only show a generalised level of deprivation for geographic areas, so will not reflect the circumstances of all people in those areas. Certificates are means-tested and are still issued to applicants from less deprived areas if they meet the conditions. In 2025/26, 14,600 HC2 certificates and 8,830 HC3 certificates went to applicants from quintile 5, the least deprived areas.

The indices of deprivation used in this publication are specific to England, so can only be applied to certificates assigned to an English address. Current mid-year population estimates by IMD were unavailable at time of publication.

Number of NHS Low Income Scheme certificates issued per 10,000 population, by ICB in 2025/26

The map, chart and table are based on the total combined number of HC2 and HC3 certificates issued in 2025/26. Figures for individual certificate types are included in the supporting data.

Map
Figure 12 (map): Certificates issued per 10,000 population varies by ICB area

Number of NHS Low Income Scheme certificates issued in 2025/26, by ICB area, per 10,000 population aged 16 and over

Chart
Figure 12 (chart): Certificates issued per 10,000 population varies by ICB area

Number of NHS Low Income Scheme certificates issued in 2025/26, by ICB area, per 10,000 population aged 16 and over

Table
Table 12: Certificates issued per 10,000 population varies by ICB area

Number of NHS Low Income Scheme certificates issued in 2025/26, by ICB area, per 10,000 population aged 16 and over

ICB name Number of issued certificates per 10,000 population Number of certificates issued Population:ONS mid-year estimate 2024 (aged 16+)
NHS Birmingham and Solihull Integrated Care Board 81 8,892 1,102,221
NHS North West London Integrated Care Board 79 14,195 1,787,403
NHS North Central London Integrated Care Board 75 8,820 1,172,639
NHS North East London Integrated Care Board 75 12,526 1,676,814
NHS Black Country Integrated Care Board 70 6,933 996,447
NHS North East and North Cumbria Integrated Care Board 61 15,649 2,557,182
NHS Greater Manchester Integrated Care Board 61 14,591 2,402,706
NHS South Yorkshire Integrated Care Board 61 7,173 1,168,140
NHS Leicester, Leicestershire and Rutland Integrated Care Board 60 5,778 958,389
NHS Mid and South Essex Integrated Care Board 59 5,943 1,001,995
NHS South East London Integrated Care Board 59 8,915 1,499,641
NHS West Yorkshire Integrated Care Board 56 11,248 1,999,783
NHS Nottingham and Nottinghamshire Integrated Care Board 56 5,427 974,999
NHS South West London Integrated Care Board 50 6,301 1,254,855
NHS Bristol, North Somerset and South Gloucestershire Integrated Care Board 50 4,271 847,832
NHS Coventry and Warwickshire Integrated Care Board 49 4,005 812,054
NHS Cheshire and Merseyside Integrated Care Board 48 10,250 2,155,545
NHS Northamptonshire Integrated Care Board 48 3,155 655,093
NHS Derby and Derbyshire Integrated Care Board 47 4,279 904,248
NHS Kent and Medway Integrated Care Board 46 7,089 1,556,328
NHS Lancashire and South Cumbria Integrated Care Board 46 6,697 1,469,087
NHS Sussex Integrated Care Board 46 6,694 1,467,465
NHS Lincolnshire Integrated Care Board 45 2,961 659,081
NHS Bedfordshire, Luton and Milton Keynes Integrated Care Board 45 3,750 837,901
NHS Staffordshire and Stoke-on-Trent Integrated Care Board 44 4,239 967,595
NHS Hertfordshire and West Essex Integrated Care Board 44 5,429 1,238,938
NHS Shropshire, Telford and Wrekin Integrated Care Board 39 1,695 436,914
NHS Dorset Integrated Care Board 39 2,635 674,881
NHS Hampshire and Isle of Wight Integrated Care Board 39 6,029 1,554,407
NHS Gloucestershire Integrated Care Board 39 2,142 552,288
NHS Herefordshire and Worcestershire Integrated Care Board 38 2,552 676,644
NHS Frimley Integrated Care Board 38 2,454 642,304
NHS Humber and North Yorkshire Integrated Care Board 38 5,578 1,455,578
NHS Cambridgeshire and Peterborough Integrated Care Board 38 2,921 773,687
NHS Devon Integrated Care Board 37 3,892 1,056,618
NHS Suffolk and North East Essex Integrated Care Board 36 3,046 846,703
NHS Norfolk and Waveney Integrated Care Board 35 3,121 887,814
NHS Cornwall and the Isles of Scilly Integrated Care Board 35 1,738 492,459
NHS Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board 34 5,113 1,507,984
NHS Surrey Heartlands Integrated Care Board 32 2,831 878,273
NHS Somerset Integrated Care Board 30 1,467 489,617
NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care Board 30 2,371 801,301

ICB areas have been used to allow comparisons between areas, however ICBs are not responsible for applications to the NHS Low Income Scheme. Applicants have been aligned to an ICB area based on their postcode, which is only possible for applicants within England.

Population estimates use figures published by the ONS for ICB population. These figures are mid-year estimates with 2024 population estimates used for this report, the latest available at the time of publication. To align with the people who may benefit from the NHS Low Income Scheme, population figures have been limited to people aged 16 and over.

An estimated 81 certificates were issued per 10,000 population in Birmingham and Solihull ICB, the highest of all ICBs in 2025/26. Of the 4 ICBs with the most certificates issued per 10,000 population, the other 3 were in North London.

In 2025/26 the lowest estimated number of certificates issued per 10,000 population was 30, in Bath and North East Somerset, Swindon and Wiltshire ICB. Somerset ICB also had 30 certificates issued per 10,000 population in 2025/26 but was slightly higher in unrounded totals than Bath and North East Somerset, Swindon and Wilshire ICB.

2.4. NHS Prescription Prepayment Certificate (PPC)

A PPC can help provide savings for people who pay for their NHS Prescriptions. The certificate covers all NHS prescription charges for a set price within a given time period. Patients could save money if they need 4 or more items in 3 months or 12 or more items in 12 months.

PPCs can be purchased in-person at some pharmacies or direct via the PPC webpage. Applicants can choose between a 3-month and 12-month certificate.

Only a small proportion of applications would not end with a certificate being issued. Certificates will not be issued if there are issues with the initial payment for the certificate and in some cases the applicant may drop out for other reasons. Due to the time taken to resolve an application, some certificates may be issued in a later time period to when the application was submitted.

Patients receiving prescriptions for hormone replacement therapy (HRT) may benefit more from the Hormone Replacement Therapy Prescription Prepayment Certificate (HRT PPC).

As a PPC provides support with NHS prescription charges, support is only applicable to applicants from England aged between 16 and 59.

Number of PPCs issued from 2018/19 to 2025/26, split by PPC type

In 2025/26 there were 3.2 million PPCs issued.

The number of 12-month PPCs issued and 3-month PPCs issued both increased in 2025/26.

Chart
Figure 13: The total number of PPCs issued has increased each year since 2020/21

Number of PPCs issued from 2018/19 to 2025/26, split by PPC type

Table
Table 13: The total number of PPCs issued has increased each year since 2020/21

Number of PPCs issued from 2018/19 to 2025/26, split by PPC type

Certificate type Financial year Number of certificates issued
12-month 2018/2019 1,451,884
12-month 2019/2020 1,629,702
12-month 2020/2021 1,673,940
12-month 2021/2022 1,810,384
12-month 2022/2023 1,979,387
12-month 2023/2024 2,066,011
12-month 2024/2025 2,191,197
12-month 2025/2026 2,241,195
3-month 2018/2019 841,271
3-month 2019/2020 898,303
3-month 2020/2021 833,134
3-month 2021/2022 876,657
3-month 2022/2023 923,472
3-month 2023/2024 936,322
3-month 2024/2025 983,745
3-month 2025/2026 1,008,206

The number of 12-month PPCs issued has increased every year since 2018/19, with 2.2 million 12-month certificates issued in 2025/26. This was 2.3% more than the 2.2 million 12-month certificates in 2024/25. More than twice as many 12-month certificates were issued in 2025/26 than the number of 3-month certificates.

After a decrease in 2020/21, the number of 3-month certificates has increased every year since. In 2025/26, there were 1 million 3-month certificates issued, a 2.5% increase from 984,000 in 2024/25. This was a similar percentage increase as for 12-month certificates in the same period.

Number of PPCs issued by age of applicant, split by PPC type in 2025/26

The number of certificates issued increased with age for 12-month and 3-month PPCs in 2025/26.

In 2025/26, there were a total of 841,000 certificates issued to people aged 55-59.

Chart
Figure 14: The number of certificates issued rises as the age of the applicant rises

Number of PPCs issued in 2025/26, split by PPC type and age of applicant

Table
Table 14: The number of certificates issued rises as the age of the applicant rises

Number of PPCs issued in 2025/26, split by PPC type and age of applicant

Certificate type Age band Number of certificates issued
12-month 15-19 20,858
12-month 20-24 92,158
12-month 25-29 127,595
12-month 30-34 157,221
12-month 35-39 195,506
12-month 40-44 253,468
12-month 45-49 335,115
12-month 50-54 497,661
12-month 55-59 561,600
3-month 15-19 14,328
3-month 20-24 55,944
3-month 25-29 65,985
3-month 30-34 78,244
3-month 35-39 93,744
3-month 40-44 114,428
3-month 45-49 134,789
3-month 50-54 171,294
3-month 55-59 279,433

The number of 12-month certificates issued increases by applicant age. The number of 12-month certificates issued for people aged 15-19 in 2025/26 was 20,900, compared to 562,000 for people aged 55-59. The number of 3-month certificates issued is lower, but shows a similar pattern across age groups. In 2025/26 there were 14,300 3-month certificates issued to people aged 15-19, and 279,000 certificates issued to people aged 55-59.

A PPC only provides support for NHS prescription charges. Therefore, it is not needed after the age of 60, when NHS prescriptions are automatically free. For applicants who choose to auto-renew their certificate, the certificate will not be renewed if they turn 60 within 9 months of their existing certificate expiring.

Across all age groups, more people received a 12-month certificate than a 3-month certificate. The ratio of 12-month to 3-month certificates generally increases across older age groups. In the 15-19 age group, 1.5 times more 12-month PPCs were issued compared to the number of 3-month PPCs. This rises to almost 3 times more 12-month PPCs than 3-month PPCs in the 50-54 age group. It then falls to 2 times more 12-month than 3-month PPCs for the 55-59 age group.

Number of PPCs issued by deprivation profile, split by PPC type in 2025/26

Chart
Figure 15: Slightly fewer 12-month certificates are issued in the most and least deprived areas

Number of PPCs issued in 2025/26, split by PPC type and IMD quintile

Table
Table 15: Slightly fewer 12-month certificates are issued in the most and least deprived areas

Number of PPCs issued in 2025/26, split by PPC type and IMD quintile

Certificate type IMD quintile Number of certificates issued
12-month 1 421,777
12-month 2 448,118
12-month 3 470,309
12-month 4 474,445
12-month 5 425,171
3-month 1 203,495
3-month 2 209,926
3-month 3 203,247
3-month 4 202,001
3-month 5 189,150

Across IMD quintiles, there is not an obvious pattern to the number of PPCs issued. In 2025/26 there were fewer 12-month certificates issued to the most and least deprived areas of the country than the other 3 IMD quintiles. For 3-month certificates, the least deprived areas in quintile 5 have fewer certificates issued than other quintiles, but there is also no clear pattern of this increasing with deprivation.

People may be more likely to qualify for other income-related benefits that provide access to free NHS prescriptions in the most deprived areas.

Current mid-year population estimates by IMD were unavailable at time of publication.

Number of PPCs issued per 10,000 population, by ICB in 2025/26

The map, chart and table are based on the total number of 3-month and 12-month certificates issued in 2025/26. Figures for individual certificate types are included in the accompanying data.

Map
Figure 16 (map): Certificates issued per 10,000 population varies by ICB area

Number of PPCs issued in 2025/26, by ICB area, per 10,000 population aged 16 to 59 receiving NHS prescriptions

Chart
Figure 16 (chart): Certificates issued per 10,000 population varies by ICB area

Number of PPCs issued in 2025/26, by ICB area, per 10,000 population aged 16 to 59 receiving NHS prescriptions

Table
Table 16: Certificates issued per 10,000 population varies by ICB area

Number of PPCs issued in 2025/26, by ICB area, per 10,000 population aged 16 to 59 receiving NHS prescriptions

ICB name Number of issued certificates per 10,000 population Number of certificates issued Population:Estimated patients (aged 16-59) receiving NHS prescribing (2025/2026)
NHS Lincolnshire Integrated Care Board 2,776 60,249 217,073
NHS Cornwall and the Isles of Scilly Integrated Care Board 2,564 39,474 153,972
NHS Humber and North Yorkshire Integrated Care Board 2,376 124,355 523,391
NHS Norfolk and Waveney Integrated Care Board 2,370 71,375 301,210
NHS Northamptonshire Integrated Care Board 2,271 59,261 260,992
NHS Suffolk and North East Essex Integrated Care Board 2,242 67,233 299,837
NHS Cambridgeshire and Peterborough Integrated Care Board 2,115 60,858 287,702
NHS South Yorkshire Integrated Care Board 2,079 106,284 511,246
NHS Lancashire and South Cumbria Integrated Care Board 2,078 123,710 595,367
NHS Shropshire, Telford and Wrekin Integrated Care Board 2,076 30,993 149,272
NHS Staffordshire and Stoke-on-Trent Integrated Care Board 2,058 78,831 383,011
NHS Cheshire and Merseyside Integrated Care Board 2,009 182,521 908,678
NHS Coventry and Warwickshire Integrated Care Board 1,989 64,698 325,310
NHS North East and North Cumbria Integrated Care Board 1,968 206,480 1,049,422
NHS Somerset Integrated Care Board 1,885 31,433 166,792
NHS Leicester, Leicestershire and Rutland Integrated Care Board 1,881 70,512 374,837
NHS Derby and Derbyshire Integrated Care Board 1,871 68,897 368,259
NHS Herefordshire and Worcestershire Integrated Care Board 1,868 44,869 240,146
NHS Devon Integrated Care Board 1,849 68,375 369,866
NHS Nottingham and Nottinghamshire Integrated Care Board 1,835 73,524 400,740
NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care Board 1,829 53,140 290,543
NHS Greater Manchester Integrated Care Board 1,752 192,664 1,099,666
NHS Dorset Integrated Care Board 1,750 42,214 241,218
NHS Kent and Medway Integrated Care Board 1,723 101,851 591,166
NHS Mid and South Essex Integrated Care Board 1,721 70,166 407,619
NHS Hampshire and Isle of Wight Integrated Care Board 1,685 100,473 596,323
NHS Gloucestershire Integrated Care Board 1,655 33,907 204,834
NHS West Yorkshire Integrated Care Board 1,582 142,739 902,272
NHS Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board 1,577 88,619 562,109
NHS Hertfordshire and West Essex Integrated Care Board 1,576 78,351 497,029
NHS Bedfordshire, Luton and Milton Keynes Integrated Care Board 1,575 55,520 352,411
NHS Sussex Integrated Care Board 1,555 87,058 559,729
NHS Black Country Integrated Care Board 1,468 65,087 443,444
NHS Birmingham and Solihull Integrated Care Board 1,444 74,870 518,327
NHS Bristol, North Somerset and South Gloucestershire Integrated Care Board 1,316 45,476 345,442
NHS Frimley Integrated Care Board 1,257 33,348 265,314
NHS Surrey Heartlands Integrated Care Board 1,182 41,537 351,499
NHS South West London Integrated Care Board 1,034 54,899 530,697
NHS North East London Integrated Care Board 1,032 76,653 742,752
NHS North West London Integrated Care Board 959 69,138 720,997
NHS North Central London Integrated Care Board 958 47,175 492,576
NHS South East London Integrated Care Board 943 58,822 623,926

ICB areas have been used to allow comparisons between areas, with applicants aligned to an ICB area based on their postcode.

Population estimates are based on the number of patients, aged 16-59, identified receiving NHS prescriptions during 2025/26. The population estimates include all patients regardless of whether or not they paid prescription charges in 2025/26. These population estimates may exclude patients who cannot be identified in the NHS prescriptions dataset, or those who cannot be assigned to an ICB or age group from the available data.

The ICBs in 2025/26 with the 5 lowest numbers of certificates issued per 10,000 population were all London ICBs. South East London ICB had the least, with 943 certificates issued per 10,000 population in 2025/26.

The ICB with the highest certificates issued per 10,000 population in 2025/26 was Lincolnshire ICB, with 2780.

2.5. HRT PPC

The HRT PPC was introduced on 1 April 2023 to provide support with the prescription costs for medication used to treat symptoms of the menopause.

The HRT PPC covers all NHS prescription charges for certain HRT medicines for a set price. HRT PPCs are valid for 12 months and patients could save money if they need 3 or more HRT prescription items in 12 months.

The HRT PPC can be used for any of the applicable HRT medicines, regardless of why they are prescribed. The HRT PPC webpages include a list of the medicines covered by a HRT PPC.

HRT PPCs can be purchased in-person at some pharmacies or direct via the HRT PPC webpage.

Only a small proportion of applications would not end with a certificate being issued. Certificates will not be issued if there are issues with the initial payment for the certificate and in some cases the applicant may drop out for other reasons. Due to the time taken to resolve an application, some certificates may be issued in a later time period to when the application was submitted.

If a patient’s medication is not covered, or they also receive prescriptions for other medication, they may benefit more from a 3 or 12 month PPC that covers all NHS prescriptions.

As an HRT PPC provides support with NHS prescription charges, support is generally only applicable to applicants from England aged between 16 and 59.

Number of HRT PPCs issued in 2025/26

In 2025/26, there were 572,000 HRT PPCs issued.

The number of HRT PPCs issued has increased by 6% since 2024/25.

Chart
Figure 17: July 2025 had the highest number of certificates issued in 2025/26

Number of HRT PPCs issued by month, April 2023 to March 2026

Supporting Information
Figure 17 (post-dated certificates): March in each year had a sharp increase in the proportion of certificates post-dated to start the following month

Proportion of issued HRT PPCs post-dated to start the following month, by month of certificate issue

Table
Table 17: July 2025 had the highest number of certificates issued in 2025/26

Number of HRT PPCs issued by month, April 2023 to March 2026

Month Number of certificates issued Issued certificates post-dated to start the following month (%)
Apr-23 130,604 14.9
May-23 87,455 9.9
Jun-23 66,862 7.9
Jul-23 51,650 10.8
Aug-23 40,434 9.5
Sep-23 32,646 8.2
Oct-23 29,286 9.3
Nov-23 25,733 8.5
Dec-23 19,408 7.3
Jan-24 23,119 10.6
Feb-24 21,225 10.1
Mar-24 37,607 45.3
Apr-24 52,980 28.0
May-24 59,561 20.4
Jun-24 59,566 16.5
Jul-24 60,399 13.9
Aug-24 49,960 13.3
Sep-24 45,079 14.2
Oct-24 43,103 13.8
Nov-24 36,657 11.4
Dec-24 30,437 11.6
Jan-25 34,437 13.9
Feb-25 28,062 12.0
Mar-25 41,982 31.5
Apr-25 43,017 25.7
May-25 48,815 21.2
Jun-25 50,259 17.6
Jul-25 54,740 15.3
Aug-25 51,218 15.9
Sep-25 51,861 14.6
Oct-25 51,169 13.8
Nov-25 45,499 12.5
Dec-25 41,499 11.1
Jan-26 44,534 14.1
Feb-26 38,462 10.8
Mar-26 51,343 22.3

In 2025/26 the total number of certificates increased compared to 2024/25. There were 572,000 HRT PPCs issued in 2025/26, an increase of 5.6% from 542,000 certificates issued in 2024/25. The total for 2025/26 was also higher than the 566,000 certificates issued in the first year of the service in 2023/24.

July 2025 remained the month with the largest number of certificates issued in 2025/26, but from April 2025 to July 2025 the number of certificates issued by month was lower than the same month in the previous year. From August 2025 to March 2026, the number of certificates issued each month was higher than the same months in the previous year, driving the overall increase for 2025/26.

Certificates are valid for 12 months, so certificates issued early in 2023/24 began to expire in early 2024/25, while certificates issued in early 2024/25 began to expire in early 2025/26. In a similar pattern to 2023/24 and 2024/25, the number of certificates issued rose steeply in March, the last month of the 2025/26 financial year. Over a fifth of certificates issued in March 2026 had a certificate start date in April 2026. This may be due to customers renewing expiring certificates.

There were 54,700 certificates issued in July 2025, the highest by month in 2025/26. This was 9.6% of the total for the financial year, but lower than the 60,400 certificates in July 2024. The distribution of certificates issued by month across 2025/26 varied less than in 2023/24 or 2024/25.

Number of HRT PPCs issued by age of applicant in 2025/26

90% of HRT PPCs in 2025/26 were issued to people aged 45 and over.

50-54 was the age group with the most HRT PPCs issued in 2025/26.

Chart
Figure 18: Most people issued HRT PPCs were aged 45 and over

Number of HRT PPCs issued in 2025/26, split by age of applicant

Supporting Information
Figure 18 (NHS prescribing): Most patients receiving HRT PPC eligible medication were aged 45 and over

Estimated number of patients receiving NHS prescribing in 2025/26 of medication qualifying for support by HRT PPC, split by patient age band

Table
Table 18: Most people issued HRT PPCs were aged 45 and over

Number of HRT PPCs issued in 2025/26, split by age of applicant

Age band Number of certificates issued Estimated patients receiving HRT PPC qualifying medication (2025/2026)
15-19 167 4,706
20-24 894 14,288
25-29 1,093 19,884
30-34 1,449 27,014
35-39 5,596 48,527
40-44 45,712 169,498
45-49 149,784 446,806
50-54 211,634 663,414
55-59 156,087 603,173

In 2025/26, over 90% of HRT PPCs were issued to people aged 45 to 59. Higher numbers of HRT PPCs in these age groups may be expected as menopause usually affects women between the ages of 45 and 55. The 50-54 age group had the highest number of certificates issued, at 212,000.

The distribution of HRT PPCs by age is similar to the distribution of the estimated number of patients receiving HRT qualifying medication on NHS prescriptions in 2025/26. They both increase across age bands from 15-19 to 50-54 year olds, before falling in the 55-59 age group.

Number of HRT PPCs issued by deprivation profile in 2025/26

Only 38,000 HRT PPCs were issued in the most deprived areas in 2025/26.

In 2025/26 in the least deprived areas, 184,000 HRT PPCs were issued..

Chart
Figure 19: The number of HRT PPCs issued rises as deprivation decreases

Number of HRT PPCs issued in 2025/26, by IMD quintile

Supporting Information
Figure 19 (eligible patients): Patients in the least deprived areas are more likely to receive prescribing of HRT medication

Estimated number of patients receiving NHS prescribing in 2025/26 of medication qualifying for support by HRT PPC, split by IMD quintile

Table
Table 19: The number of HRT PPCs issued rises as deprivation decreases

Number of HRT PPCs issued in 2025/26, by IMD quintile

IMD quintile Number of certificates issued Estimated patients receiving HRT PPC qualifying medication (aged 16-59)
1 37,981 250,328
2 77,465 315,990
3 120,507 378,607
4 152,175 437,378
5 184,054 500,312

In 2025/26, there remained a clear pattern in the number of HRT PPCs issued decreasing with deprivation. There were 184,000 certificates issued in the quintile 5, the least deprived areas. This was 4.8 times higher than the 38,000 certificates issued in the most deprived areas in 2025/26.

Across quintiles in 2025/26, the distribution of HRT PPCs by deprivation is similar to the distribution of the estimated number of patients receiving HRT qualifying medication on NHS prescriptions. However, the difference between quintile 1 and quintile 2 is more pronounced for HRT PPCs. There were 20% fewer estimated HRT patients in quintile 1 than quintile 2 in 2025/26, but 50% fewer HRT PPCs. In the most deprived areas, people may be more likely to qualify for other methods of help with health costs.

Number of HRT PPCs issued per 10,000 population, by ICB in 2025/26

Map
Figure 20 (map): ICBs in the South and South West generally have higher rates of HRT PPCs than the rest of England

Number of HRT PPCs issued in 2025/26 by ICB area per 10,000 patients receiving NHS prescribing of eligible medication

Chart
Figure 20 (chart): ICBs in the South and South West generally have higher rates of HRT PPCs than the rest of England

Number of HRT PPCs issued in 2025/26 by ICB area per 10,000 patients receiving NHS prescribing of eligible medication

Table
Table 20: ICBs in the South and South West generally have higher rates of HRT PPCs than the rest of England

Number of HRT PPCs issued in 2025/26 by ICB area per 10,000 patients receiving NHS prescribing of eligible medication

ICB name Number of issued certificates per 10,000 population Number of certificates issued Population:Estimated patients (aged 16-59) receiving HRT PPC qualifying medication (2025/2026)
NHS South West London Integrated Care Board 3,683 17,970 48,786
NHS Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board 3,676 24,999 67,999
NHS Surrey Heartlands Integrated Care Board 3,548 17,497 49,321
NHS Cornwall and the Isles of Scilly Integrated Care Board 3,505 7,581 21,630
NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care Board 3,433 13,415 39,080
NHS Devon Integrated Care Board 3,410 16,767 49,163
NHS Somerset Integrated Care Board 3,392 7,803 23,006
NHS Sussex Integrated Care Board 3,389 26,196 77,304
NHS Herefordshire and Worcestershire Integrated Care Board 3,376 10,315 30,557
NHS Hertfordshire and West Essex Integrated Care Board 3,375 19,217 56,939
NHS Gloucestershire Integrated Care Board 3,362 9,355 27,828
NHS South East London Integrated Care Board 3,345 16,216 48,480
NHS Dorset Integrated Care Board 3,341 10,206 30,550
NHS Bristol, North Somerset and South Gloucestershire Integrated Care Board 3,334 13,519 40,544
NHS Shropshire, Telford and Wrekin Integrated Care Board 3,267 5,658 17,318
NHS Kent and Medway Integrated Care Board 3,254 21,292 65,432
NHS Frimley Integrated Care Board 3,247 9,722 29,942
NHS Norfolk and Waveney Integrated Care Board 3,200 10,903 34,076
NHS Mid and South Essex Integrated Care Board 3,159 12,172 38,531
NHS North Central London Integrated Care Board 3,150 11,349 36,029
NHS Lincolnshire Integrated Care Board 3,111 6,330 20,349
NHS Hampshire and Isle of Wight Integrated Care Board 3,097 22,728 73,396
NHS Derby and Derbyshire Integrated Care Board 3,084 11,961 38,787
NHS North West London Integrated Care Board 3,080 13,422 43,584
NHS Humber and North Yorkshire Integrated Care Board 3,069 17,616 57,400
NHS Cambridgeshire and Peterborough Integrated Care Board 3,049 8,940 29,320
NHS Suffolk and North East Essex Integrated Care Board 3,037 9,951 32,770
NHS Coventry and Warwickshire Integrated Care Board 2,905 8,732 30,059
NHS Bedfordshire, Luton and Milton Keynes Integrated Care Board 2,905 8,376 28,835
NHS Leicester, Leicestershire and Rutland Integrated Care Board 2,863 9,389 32,798
NHS West Yorkshire Integrated Care Board 2,831 22,965 81,119
NHS Nottingham and Nottinghamshire Integrated Care Board 2,799 10,652 38,051
NHS Staffordshire and Stoke-on-Trent Integrated Care Board 2,705 9,525 35,210
NHS Lancashire and South Cumbria Integrated Care Board 2,696 15,613 57,913
NHS North East London Integrated Care Board 2,665 9,331 35,015
NHS Northamptonshire Integrated Care Board 2,642 6,995 26,480
NHS Cheshire and Merseyside Integrated Care Board 2,569 24,871 96,821
NHS Birmingham and Solihull Integrated Care Board 2,536 8,001 31,552
NHS Greater Manchester Integrated Care Board 2,532 22,487 88,804
NHS South Yorkshire Integrated Care Board 2,498 11,240 44,994
NHS North East and North Cumbria Integrated Care Board 2,458 24,601 100,091
NHS Black Country Integrated Care Board 2,356 6,304 26,752

ICB areas have been used to allow comparisons between areas, with applicants aligned to an ICB area based on their postcode.

Population estimates are based on the number of patients, aged 16-59, identified as receiving NHS prescriptions for drugs covered by the HRT PPC during 2025/26. The population estimates include all patients regardless of whether or not they paid prescription charges in 2025/26. These population estimates may exclude patients who cannot be identified in the NHS prescriptions dataset, or those who cannot be assigned to an ICB or age group from the available data.

In 2025/26, the number of certificates issued per 10,000 population varied across ICBs, from 2,360 in Black Country ICB to 3,680 in South West London ICB.

Across England, ICBs in the South and South West regions tend to have a higher number of HRT PPCs issued per 10,000 than ICBs in other regions.

3. About these statistics

3.1. Statistical Disclosure Control (SDC)

Statistical disclosure control has been applied to these statistics. Volume figures have been redacted in the supporting summary tables if they relate to fewer than 5 items or patients. Further information about our statistical disclosure control protocol can be found on our website.

3.2. Rounding

The high-level figures in this statistical summary have been rounded where appropriate for clarity. In most cases, rounding has been to 2 significant figures in the key findings and information boxes and 3 significant figures in the charts, maps, and main text. This is to make this narrative as accessible as possible to all readers. The summary tables released with this publication allow users to investigate this data at lower levels of granularity. Figures in the supplementary tables have not been rounded.

3.3. Index of deprivation

The English Indices of Deprivation 2025 have been used to provide a measure of deprivation. The English Indices of Deprivation are an official national measure of deprivation that follows an established methodological framework to capture a wide range of individuals’ living conditions.

The reported IMD quintile, where 1 is the most deprived and 5 the least deprived, is derived from the postcode currently held for an applicant. Postcodes are usually provided during application process. Some applicants may update postcode details when addresses change. The postcode used for these statistics will represent the latest known postcode information. There are a small number of records each year that we have reported as IMD quintile being “not available”. These are applicants with no fixed abode or with British forces addresses, or where we have been unable to match the applicant postcode to an English postcode in the National Statistics Postcode Lookup (NSPL) - February 2026.

The number of certificates where IMD quintile is not available is not presented in the charts or tables in this report, but is available in the data downloads and the supporting summary excel tables. This represents only a small number of certificates for each service.

IMD quintiles are calculated by ranking census lower-layer super output areas (LSOAs) from most deprived to least deprived and dividing them into equal groups. These range from the most deprived 20% (quintile 1) of small areas nationally to the least deprived 20% (quintile 5) of small areas nationally.

3.4. ICB classification

ICB areas have been used to allow comparisons between areas. The ICB organisational structure changed in April 2026, but this release uses the ICB 2023 structure which was in place during the time period covered by the data.

Applicants have been associated with an ICB area based on their postcode using the National Statistics Postcode Lookup (NSPL) - February 2026. ICBs are only available within England, so this geography classification is only available for applicants with a valid English postcode.

3.5. Age classification

Reporting by age band uses the applicants age at the time of application. Figures have been grouped into 5 year age bands. The age is calculated using the captured date of birth information for the applicant. If the date of birth is not available the age will be reported as “not available”.

Patients under 16 do not require NHSBSA issued exemption certificates as NHS treatment is free for this age group.

Patients aged 60 and over are automatically entitled to free NHS prescriptions and therefore would not require maternity exemption certificates, medical exemption certificates, PPCs, or HRT PPCs.

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Responsible statistician: Grace Libby