England 2020/21

published 10 June 2021

Key findings

The cost of prescription items dispensed in the community in England was £9.61 billion, a 3.49% increase of £324 million from £9.28 billion in 2019/20.
The number of prescription items dispensed in the community in England was 1.11 billion, a 1.90% decrease of 21.5 million items from 1.13 billion in 2019/20.
Atorvastatin was the most dispensed drug in England in 2020/21 with 49.9 million items, while Apixaban was the drug with the highest cost of £356 million.
Sertraline 100mg tablets was the presentation with the largest absolute increase in cost between 2019/20 and 2020/21 of £78.9 million, from £21.0 million to £99.9 million.

1. Introduction

Prescription Cost Analysis (PCA) includes information about the costs and volumes of prescription items that have been dispensed in England.

These statistics describe prescription items that were prescribed in England, Scotland, Wales, Northern Ireland, and the Channel Islands that were subsequently dispensed in the community in England and submitted to the NHSBSA for reimbursement. ‘Dispensed in the community’ means a prescription was dispensed in a pharmacy, by an appliance contractor, dispensing doctor, or as a personally administered item. If a prescription item has been prescribed in England but has been dispensed elsewhere in the United Kingdom it will not be included in these statistics.

Throughout this publication the term ‘item’, short for ‘prescription item’, refers to a single instance of a drug that is listed as a separate entry on a prescription form. For example, Paracetamol 500mg tablets x28 would be listed as one item, as would Ibuprofen 200mg tablets x56.

There are many costs incurred when a dispensing contractor fulfils a prescription. The term cost refers to the basic price of the item and quantity prescribed that is reimbursed back to the contractor. This is sometimes called the ‘Net Ingredient Cost’ (NIC).

We consulted on the content and methodology used in this publication during Winter 2020/21. You can see our response to this consultation on our website. As an outcome of this consultation we have made changes to the methodology used in these statistics and expanded their content. You can see more information on these changes in the Background Information and Methodology note that accompanies this release.

This publication is a National Statistic release. National Statistics status means that PCA meets the highest standards of trustworthiness, quality, and public value and complies with all aspects of the Code of Practice for Statistics.

The designation of this publication as a National Statistic was confirmed in May 2021 following an assessment by the Office for Statistics Regulation (OSR). You can read more about this confirmation and the assessment of these statistics on the OSR website.

2. Results and commentary

2.1. Total items and cost

Source: Summary Tables - Prescription Cost Analysis - National

The cost of prescription items dispensed in England in 2020/21 was £9.61 billion. This was a 3.49% increase of £324 million from £9.28 billion in 2019/20 and a 7.41% increase of £663 million from £8.94 billion in 2014/15. This is the second consecutive year that the cost of items dispensed in England has increased following 3 consecutive years of decreases between 2015/16 and 2018/19.

Source: Summary Tables - Prescription Cost Analysis - National

There were 1.11 billion prescription items dispensed in England in 2020/21. This was a 1.90% decrease of 21.5 million from 1.13 billion items in the previous year and a 3.69% increase of 39.5 million from 1.07 billion items in 2014/15.

2.2. Dispensing by BNF chapter

These statistics use the therapeutic classifications defined in the BNF to group medicines together based on their primary therapeutic indication. The NHSBSA uses and maintains the classification system of the BNF implemented prior to the release of edition 70, including the six pseudo BNF chapters (18 to 23) created by NHS Prescription Services used to classify products that fall outside of chapters 1 to 15. Most of the presentations held in these pseudo chapters are dressings, appliances, and medical devices.

The BNF has multiple levels, in descending order from the largest grouping to smallest they are chapter, section, paragraph, sub-paragraph, chemical substance, product, and individual presentation. Presentations in chapters 20 to 23 do not have assigned BNF paragraphs, sub-paragraphs, chemical substances, or products.

Source: Summary Tables - Prescription Cost Analysis - Chapter

BNF chapter 02 - Cardiovascular System had 330 million prescription items dispensed, the largest proportion dispensed in England in 2020/21 accounting for 29.7% of all items. This was followed by chapter 04 - Central Nervous System with 219 million and 19.7% of items, and chapter 06 - Endocrine System with 115 million and 10.3% of items.

Source: Summary Tables - Prescription Cost Analysis - Chapter

BNF chapter 04 - Central Nervous System accounted for the largest proportion of costs in 2020/21, £1.71 billion, equal to 17.8% of all costs. This was followed by chapter 02 - Cardiovascular System with £1.55 billion and 16.2% of costs, and chapter 06 - Endocrine System with £1.49 billion and 15.6% of the total cost.

2.3. Generic prescribing

Source: Additional Tables - Prescription Cost Analysis - table A5

In 2020/21, 84.8% of prescription items were prescribed generically. This was an increase of 0.6 percentage points from 2019/20, and a 0.4 percentage point decrease from highest rate in the period during 2014/15. The rate of generic prescribing has remained consistent during the period, showing 1.1 percentage points of variation between 2014/15 and 2020/21. These figures exclude preparation class 4 products - appliances.

In 2020/21, generic prescribing accounted for 63.1% of the total cost of reimbursement. This was a 2.0 percentage point increase from 2019/20, and a 4.9 percentage point decrease from a high of 68.0% in 2014/15. The proportion of costs that generic prescribing accounts for have shown greater variation over the period of 7.2 percentage points. The proportion of costs for generic prescribing decreased for 4 consecutive years between 2014/2015 and 2018/19 and has increased for 2 consecutive years from 2018/2019 to 2020/2021. This pattern is mirrored in the proportion of items prescribed generically.

2.4. Top 10 most dispensed drugs

A chemical substance is the standard registered name for the active constituent of that medicine, for example Omeprazole. A chemical substance groups together individual presentations that share this active constituent. For example, Omeprazole 20mg gastro-resistant capsules and Omeprazole 40mg gastro-resistant capsules. Products in BNF chapters 20 to 23 are not assigned a chemical substance as these are dressings and appliances.

Source: Additional Tables - Prescription Cost Analysis - A3

Atorvastatin was the most dispensed chemical substance in 2020/21 with 49.9 million items. Atorvastatin is a type of statin that is used to lower cholesterol and to prevent heart disease. Five of the top 10 dispensed chemical substances belong to BNF chapter 02 - Cardiovascular System (Atorvastatin, Amlodipine, Ramipril, Bisoprolol fumarate, and Aspirin).

Source: Addtional Tables - Prescription Cost Analysis - A2

In 2020/21, Apixaban had the highest cost for items dispensed in the community in England of £356 million. Apixaban is an anticoagulant used to treat people who have had a health problem caused by a blood clot, or to prevent future blood clots. The top 10 chemical substances by cost feature 3 drugs used to treat respiratory illnesses - Beclometasone dipropionate, Fluticasone propionate (Inhalation), and Budesonide.

Only Metformin hydrochloride, used to treat diabetes mellitus, from the top 10 chemical substances by items features in the top 10 by cost. The most commonly dispensed drugs in England are also some of the cheapest per unit. The top 10 chemical substances by dispensed items have a cost per item ranging from £1.12 for Bisoprolol fumerate to £5.20 for Metformin hydrochloride with a mean cost per item of £2.09. This contrasts with the top 10 by cost, which have a cost per item ranging from £5.20 for Metformin hydrochloride to £74.69 for Enteral nutrition with a mean cost per item of £22.06.

The mean cost per item is the average calculated by dividing the total cost of the substance by the total number of items dispensed for that substance.

2.5. Dispensing by STP

Sustainability and transformation partnerships (STP) are health geographies that are formed by NHS organisations, local councils, and others to set out proposals to improve health and care for the local population. In these statistics the STP recorded here is that of the dispensing contractor as listed in NHSBSA administrative records and not the prescribing organisation of an item.

Regional variation in prescribing and dispensing trends can be influenced by a variety of factors, such as population demographics, prevalence of chronic disease, and the presence of specialist dispensing contractors within the geography. For more information on STPs and how we’ve used them in these statistics please see the Background Information and Methodology note that accompanies this release.

Source: Summary Tables - Prescription Cost Analysis - STP National | Office for National Statistics - Mid-year population estimates

The mean number of items dispensed per capita in England was 19.7 in 2020/21. Lincolnshire STP had the highest dispensed items per capita with 27.8 while Our Healthier South East London STP had the lowest with 12.8. Of the 42 STPs in England in 2020/21, 17 had a higher number of dispensed items per capita than the national average.

Source: Summary Tables - Prescription Cost Analysis - STP National | Office for National Statistics - Mid-year population estimates

The mean cost per capita of prescription items dispensed in England was £171 in 2020/21. Cambridgeshire and Peterborough STP had the highest cost per capita of £336 while Our Healthier South East London STP had the lowest of £113, the same STP with the lowest number of items per capita. Of the 42 STPs in England in 2020/21, 22 had a higher cost per capita than the national average.

2.6. Price analysis

Between 2019/20 and 2020/21 the total cost of prescription items dispensed in the community in England increased by 3.49%, equal to £324 million. However, the total number of items dispensed decreased by 1.90%, equal to 21.5 million items. This indicates that the increase in costs between 2019/20 and 2020/21 was driven by more expensive products, rather than by greater volumes of dispensing.

The charts in this section have been limited to presentations with a total cost in 2020/21 greater than £1 million.

Source: Additional Tables - Prescription Cost Analysis - A11

A unit cost for a presentation is calculated by dividing the total cost of items dispensed in the period by the total quantity. Figure 10 shows the top 10 presentations by percentage increase in unit cost between 2019/20 and 2020/21. Zonisamide 100mg capsules increased in unit cost the most in 2020/21 by 727% from 8.27p per unit to 68.4p. The largest increase in actual value of unit cost for the top 10 drugs by percentage change occurred for Phenelzine 15mg tablets, from 86.2p per unit to 391p.

Source: Additional Tables - Prescription Cost Analysis - A12

Between 2019/20 and 2020/21 the total cost Sertraline 100mg tablets increased by £78.9 million, the highest absolute change of all presentations. Sertraline 50mg tablets also had the third highest absolute change in cost of £46.7 million. Both presentations appear in Part VIIIA of the Drug Tariff for England and Wales, however a price concession was granted for each by the Department of Health and Social Care (DHSC) in the 7 months April 2020 to October 2020. Price concessions are announced when granted on the NHSBSA website.

A price concession can be granted by DHSC for products listed in Part VIIIA or Part VIIIB of the Drug Tariff. Concessions are granted in instances where dispensing contractors may face difficulties in obtaining medicines at their usual prices due to supply or other issues. DHSC set concessions using information derived from manufacturers and wholesalers and are only applicable to the months in which they are granted.

3. UK comparisons

Each devolved administration in the UK produces their own Prescription Cost Analysis statistics. There are numerous differences between each country’s release including in the way that data measures are collected and classified, the different structures of the health social care systems in each country, and methodological differences. For these reasons, any comparisons made between PCA data produced by the UK nations should be made with caution and in the wider context of the health social care landscape in the UK.

We have collated some measures that allow high level comparisons to be made between the different devolved authorities. However, please refer to each country’s individual publication for further details.

We have used the latest available PCA data from each UK nation to make these comparisons along with the latest mid-year population estimates from the Office for National Statistics (ONS). Therefore these comparisons are based on the financial year 2019/20, and not 2020/21. We have used the 2019 mid-year population estimates - the latest figures available at the time of publication - to calculate any per capita measures. The data used in this section for Wales relates to prescriptions that have been issued by GPs in Wales and subsequently dispensed in Wales or other countries in the UK. No figures for prescriptions only dispsensed in Wales were available at the time of publication.

For more information on the PCA publications of each UK nation and the differences between them, please read the Background Information and Methodology note released alongside this publication.

Source: Additional Tables - Prescription Cost Analysis - A1 | Public Health Scotland - Dispenser payments and prescription cost analysis | Welsh Government - Prescriptions in Wales | HSC Business Services Organisation - General pharmaceutical services and prescribing statistics | Office for National Statistics - Mid-year population estimates

In 2019/20, England dispensed 20.1 items per head of population. This was 0.6 items more than Scotland who had the fewest items dispensed per capita of 19.5, and 5.9 items fewer than Wales who had 26.0 items dispensed per capita.

England had the lowest prescription item cost per head of population in 2019/20 of £165. This was £70 less than Northern Ireland, £50 less than Scotland, and £23 less than Wales.

4. About these statistics

4.1. Monthly PCA data

NHSBSA Information Services also release a monthly administrative management information data set for PCA. The monthly data set is produced in line with the same methodology used in these statistics however, it is not an Official Statistic.

There is a small difference between the annual National Statistics and the monthly administrative. The geographical structure used in the annual publication is the structure at the 31 March of the given year. For the monthly data the geographical structure used is the one at the end of the given month. In the rare event that a dispensing contractor changes parent organisation during the year this will reflect in the monthly data, and may mean that STP level totals will not match between aggregated monthly data and the annual National Statistics. This will not impact national totals.

4.2. Uses of these statistics

These statistics have a variety of uses including:

obtaining a national view of costs and volumes for prescriptions dispensed in the community in England across the calendar year
analysis of cost and volume trends across various levels of the BNF hierarchy
allowing public scrutiny of national prescribing habits
monitoring uptake of new to market proprietary presentations
monitoring the proportion of prescriptions dispensed generically

4.3. Changes to this publication

Following a public consultation we held in December 2020 we have changed the methodology used in these statistics and expanded their content, including:

changing the apportionment methodology used
changing the time period covered from calendar year to financial year
further geographical breakdowns
expanded drug classifications

For full details of the changes made please refer to the Background Information and Methodology note released alongside these statistics.

4.4. Timeliness of this publication

This publication has historically been released in the month of April. To accommodate the inclusion of financial year information these statistics will now be released in June, after March data becomes available each year. Calendar year data will also be released at the same time as financial year information.

5. Statistical disclosure control

The high-level figures in this statistical summary have been rounded where appropriate for clarity, in most cases to three significant figures. 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.

6. Accessibility

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