England 2023/24

Published 6 June 2024

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Key findings

In 2023/24 1.21 billion prescription items were dispensed in the community in England at a cost of £10.9 billion.

The number of items dispensed in the community in England increased by 3% from 2022/23 while costs increased by 5%.

In England in 2023/24:

  • the cost of prescription items dispensed in the community was £10.9 billion, a 5% increase from £10.4 billion in 2022/23

  • the number of prescription items dispensed in the community in was 1.21 billion, a 3% increase from 1.18 billion in 2022/23

  • the most dispensed chemical substance was Atorvastatin, with 65 million items

  • beclometasone dipropionate was the chemical substance with the highest costs, of £320 million

  • Forxiga 10mg tablets was the presentation with the largest increase in cost from 2022/23, with an absolute increase of £90 million

1. Things you should know

1.1. Scope

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

These statistics cover prescription items submitted to the NHSBSA for reimbursement that were prescribed in England, Scotland, Wales, Northern Ireland or the Channel Islands, and subsequently dispensed in the community in England. By ‘dispensed in the community’ we mean it was dispensed at a pharmacy, by an appliance contractor, by a dispensing doctor, or as a personally administered item. Items dispensed in hospitals or prisons, for example, are not described as ‘dispensed in the community’. Prescription items prescribed in England but dispensed elsewhere in the United Kingdom are not included in these statistics.

The Pharmacy First Clinical Pathways advanced service was launched on 31 January 2024. The service allows patients to get treatment for seven common conditions directly from their local pharmacy, without the need for a GP appointment or prescription. This includes medicines to treat:

  • sinusitis
  • sore throat
  • earache
  • infected insect bite
  • impetigo (a bacterial skin infection)
  • shingles
  • uncomplicated urinary tract infections in women

Data relating to medicines supplied as part of this advanced service have been included in this publication.

This publication is an accredited official statistic release. Accredited official statistic 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). More information about this confirmation, and the assessment of these statistics, can be found on the OSR website.

1.2. Definitions

Item

A single unit of medication listed separately on a prescription form. For example, in this publication, an item might be listed as Paracetamol 500mg tablets x28, distinct from other medications that may be prescribed on the same form.

NIC

The Net Ingredient Cost (NIC) is the basic price of a single unit of a medication multiplied by the quantity prescribed. It does not include other fees incurred by dispensing contractors, such as controlled drug fees or the single activity fee. The basic price is determined by the Drug Tariff or by the manufacturer, wholesaler, or supplier of the product.

Classification

This publication uses the British National Formulary (BNF), which lists medicines used in the UK and classifies them according to their primary therapeutic use. Medication may also be prescribed for medical conditions other than their primary use. For example, certain antidepressants may be recommended to individuals experiencing chronic pain. The NHSBSA does not capture the clinical indication of a prescription during processing.

Generic prescribing

Generic prescribing is the prescribing of a drug by it’s non-proprietary name rather than a specific brand name. This allows for any suitable drug that meets the same standards as the brand name drug to be dispensed, which can result in cost savings. For example, paracetamol 500mg tablets.

Branded prescribing

Branded prescribing is the prescribing of a drug by specific brand name. For example, Panadol Advance 500mg tablets.

2. Results and commentary

2.1. Cost and number of prescription items dispensed in England

Cost of prescription items dispensed in England 2014/15 to 2023/24

Chart
Figure 1: The cost of prescription items dispensed in England has been increasing since 2018/19

Note: The y-axis does not start at zero. This is to emphasise relative changes rather than absolute values. Please consider the scale when interpreting the data.

Table
Table 1: The cost of prescription items dispensed in England has been increasing since 2018/19
Financial year Net ingredient cost (£)
2014/2015 8,942,977,355
2015/2016 9,288,532,955
2016/2017 9,193,912,890
2017/2018 9,095,228,452
2018/2019 8,833,869,091
2019/2020 9,281,576,939
2020/2021 9,605,773,673
2021/2022 9,689,467,770
2022/2023 10,425,820,708
2023/2024 10,926,112,867

Source: Summary Tables - Prescription Cost Analysis - National

Prescription items dispensed in the community in England in 2023/24 cost £10.9 billion.

There was a 5% increase in costs from 2022/23 to 2023/24.

In England, the cost of prescription items in 2023/24 was £10.9 billion, which is 5% more than the previous year’s cost of £10.4 billion. Compared to 2014/15, the cost has increased by 22%, or £1.98 billion.

Number of prescription items dispensed in England 2014/15 to 2023/24

Chart
Figure 2: The number of prescription items dispensed in England has been increasing since 2020/21

Note: The y-axis does not start at zero. This is to emphasise relative changes rather than absolute values. Please consider the scale when interpreting the data.

Table
Table 2: The number of prescription items dispensed in England has been increasing since 2020/21
Financial year Items
2014/2015 1,071,094,365
2015/2016 1,087,850,504
2016/2017 1,108,964,988
2017/2018 1,106,422,102
2018/2019 1,109,083,306
2019/2020 1,132,043,735
2020/2021 1,110,587,234
2021/2022 1,139,276,571
2022/2023 1,177,346,927
2023/2024 1,212,798,906

Source: Summary Tables - Prescription Cost Analysis - National

In 2023/24 1.21 billion items were dispensed in the community in England.

There was a 3% increase in items from 2022/23 to 2023/24.

In England, there were 1.21 billion items dispensed in 2023/24, which is 3% more than the previous year’s 1.18 billion items. Compared to 2014/15, the number of items dispensed has increased by 13%.

2.2. Cost and number of prescription items dispensed in England amongst BNF chapters

These statistics use the British National Formulary (BNF) to group medicines based on their primary therapeutic indication. The BNF has multiple levels, starting with the largest grouping called chapters, followed by sections, paragraphs, sub-paragraphs, chemical substances, products, and individual presentations.

The NHSBSA uses the BNF classification system implemented prior to the release of edition 70, which includes 6 additional chapters (18 to 23) created by NHS Prescription Services. These chapters are used to classify products that fall outside chapters 1 to 15, including dressings, appliances and medical devices.

However, presentations in chapters 20 to 23 do not have assigned BNF paragraphs, sub-paragraphs, chemical substances, or products.

Distribution of items dispensed in England amongst BNF chapters 2023/24

Chart
Figure 3: In 2023/24 BNF chapter 6 Endocrine System had the highest costs
Table
Table 3: In 2023/24 BNF chapter 6 Endocrine System had the highest costs
BNF chapter code BNF chapter name Net ingredient cost (£)
01 Gastro-Intestinal System 771,850,031
02 Cardiovascular System 1,701,922,063
03 Respiratory System 1,192,746,376
04 Central Nervous System 1,621,202,084
05 Infections 250,964,628
06 Endocrine System 1,873,422,505
07 Obstetrics, Gynaecology and Urinary-Tract Disorders 262,582,545
08 Malignant Disease and Immunosuppression 176,822,520
09 Nutrition and Blood 858,108,617
10 Musculoskeletal and Joint Diseases 138,355,462
11 Eye 168,834,732
12 Ear, Nose and Oropharynx 81,591,308
13 Skin 281,988,449
14 Immunological Products and Vaccines 150,610,025
15 Anaesthesia 23,209,998
18 Preparations used in Diagnosis 19,110
19 Other Drugs and Preparations 9,424,231
20 Dressings 170,306,399
21 Appliances 719,602,044
22 Incontinence Appliances 64,235,469
23 Stoma Appliances 408,314,271

Source: Summary Tables - Prescription Cost Analysis - Chapter

BNF chapter 6 Endocrine System accounted for 17% of total costs in 2023/24.

BNF chapter 2 Cardiovascular System accounted for 16% of total costs in 2023/24.

BNF chapter 4 Central Nervous System accounted for 15% of total costs in 2023/24.

In 2023/24, BNF chapter 6 Endocrine System had the highest costs, totalling £1.87 billion, which was equal to 17% of all costs. BNF chapter 6 includes drugs used to treat diabetes and sex hormones. Chapter 2 Cardiovascular System followed with costs of £1.70 billion, representing 16% of costs. Chapter 4 Central Nervous System had costs of £1.62 billion, 15% of the total costs.

Index of the BNF chapters with the largest percentage increase and decrease in costs from 2014/15 to 2023/24

These statistics only cover BNF chapters 01 through to 15.

Chart
Figure 4: BNF chapter 2 Cardiovascular System has shown the largest percentage increase in costs from 2014/15 to 2023/24
Table
Table 4: BNF chapter 2 Cardiovascular System has shown the greatest percentage increase in costs from 2014/15 to 2023/24
Financial year 02 - Cardiovascular System 10 - Musculoskeletal and Joint Diseases
2014/2015 100.0 100.0
2015/2016 107.3 102.1
2016/2017 108.1 91.7
2017/2018 119.4 88.3
2018/2019 123.9 90.5
2019/2020 138.9 96.9
2020/2021 152.6 77.0
2021/2022 158.7 69.9
2022/2023 163.8 64.2
2023/2024 167.2 63.7

BNF chapter 2 Cardiovascular System has shown the greatest percentage increase in costs from 2014/15 to 2023/24 of 67%.

BNF chapter 10 Musculoskeletal and Joint Diseases has shown the greatest percentage decrease in costs from 2014/15 to 2023/24 of 36%.

Within BNF chapter 2 Cardiovascular System, BNF section 2.8 Anticoagulants and protamine had the largest increase in costs from 2014/15 to 2023/24. This was an increase of 384% from £150 million in 2014/15 to £750 million in 2023/24.

Distribution of cost of items dispensed in England amongst BNF chapters 2023/24

Chart
Figure 5: In 2023/24 BNF chapter 2 Cardiovascular System had the highest number of items
Table
Table 5: In 2023/24 BNF chapter 2 Cardiovascular System had the highest number of items
BNF chapter code BNF chapter name Items
01 Gastro-Intestinal System 113,045,078
02 Cardiovascular System 358,718,901
03 Respiratory System 76,530,135
04 Central Nervous System 231,454,428
05 Infections 42,080,233
06 Endocrine System 133,711,771
07 Obstetrics, Gynaecology and Urinary-Tract Disorders 33,850,826
08 Malignant Disease and Immunosuppression 4,600,444
09 Nutrition and Blood 67,818,931
10 Musculoskeletal and Joint Diseases 31,201,188
11 Eye 15,422,310
12 Ear, Nose and Oropharynx 11,403,414
13 Skin 26,499,663
14 Immunological Products and Vaccines 11,343,854
15 Anaesthesia 1,717,771
18 Preparations used in Diagnosis 112
19 Other Drugs and Preparations 756,322
20 Dressings 5,464,320
21 Appliances 37,257,685
22 Incontinence Appliances 2,525,410
23 Stoma Appliances 7,396,110

Source: Summary Tables - Prescription Cost Analysis - Chapter

BNF chapter 2 Cardiovascular System accounted for 30% of all items dispensed in 2023/24.

BNF chapter 4 Central Nervous System accounted for 19% of all items dispensed in 2023/24.

BNF chapter 6 Endocrine System accounted for 11% of all items dispensed in 2023/24.

In 2023/24, BNF chapter 2 Cardiovascular System had the highest number of prescription items dispensed in England, with a total of 360 million items. This accounted for 30% of all items dispensed. Chapter 4 Central Nervous System followed with 230 million items, representing 19% of items. Chapter 6 Endocrine System had 130 million items, accounting for 11% of items.

Index of the BNF chapters with the largest percentage increase and decrease in items from 2014/15 to 2023/24

These statistics only cover BNF chapters 01 through to 15.

Chart
Figure 6: BNF chapter 6 Endocrine System has shown the greatest percentage increase in items from 2014/15 to 2023/24
Table
Table 6: BNF chapter 6 Endocrine System has shown the greatest percentage increase in items from 2014/15 to 2023/24
Financial year 06 - Endocrine System 13 - Skin
2014/2015 100.0 100.0
2015/2016 103.4 98.1
2016/2017 107.1 95.0
2017/2018 108.9 87.6
2018/2019 111.5 80.7
2019/2020 116.0 76.3
2020/2021 114.0 68.0
2021/2022 118.7 68.6
2022/2023 126.4 68.2
2023/2024 133.0 70.3

BNF chapter 6 Endocrine System has shown the greatest percentage increase in items from 2014/15 to 2023/24 of 33%.

BNF chapter 13 Skin has shown the greatest percentage decrease in items from 2014/15 to 2023/24 of 30%.

Within BNF chapter 6 Endocrine System, BNF section 6.4 Sex Hormones had the largest increase in items from 2014/15 to 2023/24. This was an increase of 152% from 6.4 million items in 2014/15 to 16 million items in 2023/24.

2.3. Generic prescribing and dispensing in England

Many drugs are now prescribed generically even when they are not available in generic form. For example, drugs that are listed in Category C of the Drug tariff.

Proportion of items prescribed generically and proportion of costs excluding appliances England 2014/15 to 2023/24

Chart
Figure 7: Between 2014/15 and 2023/24 the percentage of items prescribed generically has remained consistent

Note: The y-axis does not start at zero. This is to emphasise relative changes rather than absolute values. Please consider the scale when interpreting the data.

Table
Table 7: Between 2014/15 and 2023/24 the percentage of items prescribed generically has remained constant
Financial year Items (%) Net ingredient cost (%)
2014/2015 85.2 68.0
2015/2016 85.1 67.0
2016/2017 84.8 64.5
2017/2018 84.4 63.0
2018/2019 84.1 60.8
2019/2020 84.2 61.1
2020/2021 84.8 63.1
2021/2022 84.3 60.6
2022/2023 85.0 62.0
2023/2024 85.3 61.5

Source: Additional Tables - Prescription Cost Analysis - table A5

Generic items made up 85% of the total items prescribed in 2023/24.

Generic prescribing accounted for 61% of costs in 2023/24.

In 2023/24, 85% of prescription items were prescribed generically. The percentage of generic prescribing has remained consistent between 2014/15 and 2023/24. There has been a one percentage point variation in the period between 2014/15 and 2023/24. Note that these figures exclude preparation class 4 products - appliances.

In 2023/24, generic prescribing accounted for 61% of total costs. This is an increase of 1 percentage point from the previous year.

Sankey chart to show the flow of prescribing and dispensing volumes England 2023/24

Chart
Figure 8: In 2023/24 the majority of items were both prescribed and dispensed generically
Table
Table 8: In 2023/24 the majority of items were both prescribed and dispensed generically
From To Items
Total items Dressings and appliances 58,943,288
Total items Prescribed generically 984,525,199
Total items Prescribed proprietary 169,710,080
Prescribed generically Dispensed generically 919,915,368
Prescribed generically Dispensed proprietary 64,230,170
Prescribed proprietary Dispensed proprietary 169,710,080

In 2023/24 64 million of the 980 million items prescribed generically were dispensed as a proprietary.

In 2023/24 7% of items prescribed generically were dispensed as a propietary.

2.4. The 10 most dispensed chemical substances by costs and items in England

Drugs containing the same active ingredient are referred to by the same name, regardless of presentation type or if the product is branded or generic. For example, Omeprazole 20mg and Omeprazole 40mg capsules both contain the same active ingredient. The name used to identify the active substance, Omeprazole in this example, is referred to in this publication as ‘chemical substance’. Products such as dressings and appliances in BNF chapters 20 to 23 do not have a chemical substance assigned to them.

The 10 most dispensed chemical substances by cost in 2023/24

Chart
Figure 9: In England in 2023/24 beclometasone dipropionate was the chemical substance with the highest cost
Table
Table 9: In England in 2023/24 beclometasone dipropionate was the chemical substance with the highest cost
Chemical substance name Chemical substance BNF code Net ingredient cost (£)
Beclometasone dipropionate 0302000C0 316,063,223
Apixaban 0208020Z0 238,887,885
Dapagliflozin 0601023AG 234,286,832
Edoxaban 0208020AA 228,101,472
Rivaroxaban 0208020Y0 225,607,776
Omeprazole 0103050P0 154,463,339
Atorvastatin 0212000B0 151,766,104
Empagliflozin 0601023AN 145,221,289
Influenza 1404000H0 132,586,641
Beclometdiprop/formoterol/glycopyrronium 0301011AB 130,875,880

Source: Additional Tables - Prescription Cost Analysis - A2

Beclometasone dipropionate had the highest cost in 2023/24 of £320 million.

Three of the top 10 chemical substances by cost in 2023/24 are anticoagulants used to help prevent blood clots.

Two of the top 10 chemical substances by cost in 2023/24 are used to treat type 2 diabetes.

Beclometasone dipropionate had the highest cost for items dispensed in the community in England, with a total cost of £320 million. Beclometasone dipropionate is a type of medicine known as a steroid. It is primarily used for asthma, but also sometimes for chronic obstructive pulmonary disease (COPD).

The top 10 chemical substances by cost included 3 drugs that are commonly used to help prevent blood clots. These are Apixaban, Rivaroxaban, and Edoxaban.

The 10 most dispensed chemical substances by total items in 2023/24

Chart
Figure 10: In England in 2023/24 Atorvastatin was the chemical substance with the highest number of items
Table
Table 10: In England in 2023/24 Atorvastatin was the chemical substance with the highest number of items
Chemical substance name Chemical substance BNF code Items
Atorvastatin 0212000B0 65,475,356
Amlodipine 0206020A0 37,421,399
Omeprazole 0103050P0 35,670,925
Lansoprazole 0103050L0 34,722,184
Levothyroxine sodium 0602010V0 33,954,393
Ramipril 0205051R0 33,447,735
Bisoprolol fumarate 0204000H0 28,799,455
Colecalciferol 0906040G0 26,762,733
Metformin hydrochloride 0601022B0 25,380,182
Sertraline hydrochloride 0403030Q0 23,347,839

Source: Additional Tables - Prescription Cost Analysis - A3

Atorvastatin was the most dispensed chemical susbtance in 2023/24 with 65 million items.

Four of the top 10 chemical substances by items in 2023/24 belong to BNF chapter 2 Cardiovascular System.

Atorvastatin was the most dispensed chemical substance in 2023/24, with 65 million items. This medication is a type of statin commonly used to lower cholesterol and help prevent heart disease. Four of the top 10 dispensed chemical substances belong to BNF chapter 2 Cardiovascular System. These substances are Atorvastatin, Amlodipine, Ramipril, and Bisoprolol fumarate.

2.5. Cost and number of prescription items dispensed by Integrated Care Board (ICB) in England

ICB are statutory NHS organisations responsible for developing a plan for meeting the health needs of the population, managing the NHS budget, and arranging for the provision of health services in a geographical area.

It is important to note that the ICB in these statistics refers to the dispensing contractor as listed in the NHSBSA administrative records, rather than the prescribing organisation of an item.

Prescribing and dispensing trends vary regionally, and there are many factors that influence these trends, such as the presence of specialist dispensing contractors within a given area.

To find out more about ICBs and how they were used in these statistics, please refer to section 3.2 of the Background Information and Methodology note that accompanies this release.

Cost per person (£) by ICB 2023/24

Chart
Figure 11: The mean cost of items dispensed per person in England was £191 in 2023/24
Table
Table 11: The mean cost of items dispensed per person in England was £191 in 2023/24
ICB name Net ingredient cost (£) per person
NHS Cambridgeshire and Peterborough Integrated Care Board 394.36
NHS Herefordshire and Worcestershire Integrated Care Board 319.04
NHS West Yorkshire Integrated Care Board 250.72
NHS Nottingham and Nottinghamshire Integrated Care Board 239.96
NHS Cheshire and Merseyside Integrated Care Board 224.83
NHS Greater Manchester Integrated Care Board 216.29
NHS Staffordshire and Stoke-on-Trent Integrated Care Board 215.98
NHS Lincolnshire Integrated Care Board 213.13
NHS Sussex Integrated Care Board 205.62
NHS Black Country Integrated Care Board 205.53
NHS Lancashire and South Cumbria Integrated Care Board 204.86
NHS North East and North Cumbria Integrated Care Board 202.77
NHS Kent and Medway Integrated Care Board 201.66
NHS Gloucestershire Integrated Care Board 194.85
NHS South Yorkshire Integrated Care Board 194.15
NHS North West London Integrated Care Board 192.99
NHS Suffolk and North East Essex Integrated Care Board 192.00
NHS Humber and North Yorkshire Integrated Care Board 191.81
NHS Cornwall and the Isles of Scilly Integrated Care Board 191.24
NHS Dorset Integrated Care Board 190.06
NHS Norfolk and Waveney Integrated Care Board 189.57
NHS Birmingham and Solihull Integrated Care Board 183.20
NHS Devon Integrated Care Board 182.49
NHS Shropshire, Telford and Wrekin Integrated Care Board 182.18
NHS Mid and South Essex Integrated Care Board 180.82
NHS Somerset Integrated Care Board 180.81
NHS Coventry and Warwickshire Integrated Care Board 177.07
NHS Leicester, Leicestershire and Rutland Integrated Care Board 176.10
NHS Hampshire and Isle of Wight Integrated Care Board 175.28
NHS Derby and Derbyshire Integrated Care Board 168.86
NHS Hertfordshire and West Essex Integrated Care Board 165.92
NHS Northamptonshire Integrated Care Board 160.19
NHS Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board 158.07
NHS Bristol, North Somerset and South Gloucestershire Integrated Care Board 152.54
NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care Board 152.32
NHS Bedfordshire, Luton and Milton Keynes Integrated Care Board 146.08
NHS Frimley Integrated Care Board 145.27
NHS North East London Integrated Care Board 144.81
NHS North Central London Integrated Care Board 142.97
NHS Surrey Heartlands Integrated Care Board 140.93
NHS South West London Integrated Care Board 133.90
NHS South East London Integrated Care Board 130.78

Source: Summary Tables - Prescription Cost Analysis - ICB National | Office for National Statistics - Health geographies population estimates

NHS Cambridgeshire and Peterborough ICB had the highest cost per person of £394.

NHS South East London ICB had the lowest of £131.

NHS Cambridgeshire and Peterborough ICB cost per person is more than double the national average. Dispensing contractors in this ICB offer specialist stoma care, 34% of their total costs of £370 million in 2023/24 were in BNF chapter 23 Stoma Appliances.

Dispensed items per person by ICB 2023/24

Chart
Figure 12: The mean number of items dispensed per person in England was 21 in 2023/24
Table
Table 12: The mean number of items dispensed per person in England was 21 in 2023/24
ICB name Items per person
NHS West Yorkshire Integrated Care Board 30.0
NHS Lincolnshire Integrated Care Board 28.9
NHS North East and North Cumbria Integrated Care Board 28.4
NHS South Yorkshire Integrated Care Board 26.0
NHS Cheshire and Merseyside Integrated Care Board 24.6
NHS Lancashire and South Cumbria Integrated Care Board 24.3
NHS Norfolk and Waveney Integrated Care Board 24.3
NHS Suffolk and North East Essex Integrated Care Board 24.2
NHS Humber and North Yorkshire Integrated Care Board 24.2
NHS Staffordshire and Stoke-on-Trent Integrated Care Board 24.0
NHS Cornwall and the Isles of Scilly Integrated Care Board 24.0
NHS North West London Integrated Care Board 23.5
NHS Cambridgeshire and Peterborough Integrated Care Board 23.3
NHS Greater Manchester Integrated Care Board 23.3
NHS Nottingham and Nottinghamshire Integrated Care Board 22.2
NHS Black Country Integrated Care Board 21.6
NHS Coventry and Warwickshire Integrated Care Board 21.3
NHS Northamptonshire Integrated Care Board 21.2
NHS Devon Integrated Care Board 21.1
NHS Leicester, Leicestershire and Rutland Integrated Care Board 21.0
NHS Gloucestershire Integrated Care Board 20.9
NHS Herefordshire and Worcestershire Integrated Care Board 20.4
NHS Dorset Integrated Care Board 20.3
NHS Derby and Derbyshire Integrated Care Board 19.9
NHS Sussex Integrated Care Board 19.6
NHS Somerset Integrated Care Board 19.3
NHS Shropshire, Telford and Wrekin Integrated Care Board 19.2
NHS Hertfordshire and West Essex Integrated Care Board 18.9
NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care Board 18.9
NHS Mid and South Essex Integrated Care Board 18.7
NHS Birmingham and Solihull Integrated Care Board 18.6
NHS Kent and Medway Integrated Care Board 18.5
NHS Hampshire and Isle of Wight Integrated Care Board 17.8
NHS North East London Integrated Care Board 17.6
NHS Bristol, North Somerset and South Gloucestershire Integrated Care Board 16.7
NHS South West London Integrated Care Board 16.3
NHS Bedfordshire, Luton and Milton Keynes Integrated Care Board 16.2
NHS North Central London Integrated Care Board 16.0
NHS Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board 15.6
NHS Frimley Integrated Care Board 15.0
NHS South East London Integrated Care Board 14.2
NHS Surrey Heartlands Integrated Care Board 13.5

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

NHS West Yorkshire ICB had the highest dispensed items per person with 30.

NHS Surrey Heartlands ICB had the lowest with 14.

2.6. Top presentations by changes in unit and total costs

Presentation is the name given to the specific type, strength, and formulation of a drug; or, the specific type of an appliance. For example, Paracetamol 500mg tablets.

The charts in this section have been limited to presentations with a total cost in 2023/24 greater than £1 million.

A unit cost for a presentation is calculated by dividing the total cost of items dispensed in the period by the total quantity.

Price concessions can be granted by the Department of Health and Social Care (DHSC) for medicines that pharmacists are struggling to obtain at or below the price set out in the Drug Tariff. These concessions can have large impacts on the unit costs of drugs.

Top 10 presentations by percentage increase in unit cost 2022/23 to 2023/24

Chart
Figure 13: Riluzole 50mg tablets had the highest increase in unit cost from 2022/23 to 2023/24
Table
Table 13: Riluzole 50mg tablets had the highest increase in unit cost from 2022/23 to 2023/24
Presentation name Unit of measure Unit cost increase (%)
Riluzole 50mg tablets tablet 1,446
Sertraline 50mg/5ml oral suspension ml 545
Rasagiline 1mg tablets tablet 330
Betahistine 16mg tablets tablet 318
Ezetimibe 10mg tablets tablet 314
Uniphyllin Continus 200mg tablets tablet 300
Rizatriptan 10mg orodispersible tablets sugar free tablet 281
Pantoprazole 40mg gastro-resistant tablets tablet 224
Letrozole 2.5mg tablets tablet 210
Pantoprazole 20mg gastro-resistant tablets tablet 209

Source: Additional Tables - Prescription Cost Analysis - A11

Riluzole 50mg tablets had the highest increase in unit cost from 2022/23 to 2023/24, an increase of 1,405%. Riluzole is primarily used in patients with amyotrophic lateral sclerosis, a form of motor neurone disease.

Top 10 presentations by percentage decrease in unit cost 2022/23 to 2023/24

Chart
Figure 14: Lacosamide 100mg tablets had the highest decrease in unit cost from 2022/23 to 2023/24
Table
Table 14: Lacosamide 100mg tablets had the highest decrease in unit cost from 2022/23 to 2023/24
Presentation name Unit of measure Unit cost decrease (%)
Lacosamide 100mg tablets tablet -83.6
Lacosamide 200mg tablets tablet -83.1
Alendronic acid 70mg tablets tablet -67.1
Sitagliptin 25mg tablets tablet -65.7
Sodium cromoglicate 2% eye drops ml -58.7
Melatonin 2mg modified-release tablets tablet -58.0
Losartan 100mg tablets tablet -57.2
Losartan 12.5mg tablets tablet -55.0
Aripiprazole 10mg tablets tablet -54.0
Venlafaxine 225mg modified-release capsules capsule -53.3

Source: Additional Tables - Prescription Cost Analysis - A12

Lacosamide 100mg tablets had the highest decrease in unit cost from 2022/23 to 2023/24, a decrease of 84%. This was followed closely by Lacosamide 200mg tablets, with a decrease of 83%. Lacosamide is used primarily in the control of epilepsy symptoms.

Top 10 presentations by increase in total cost 2022/23 to 2023/24

Chart
Figure 15: Forxiga 10mg tablets had the highest increase in total costs from 2022/23 to 2023/24
Table
Table 15: Forxiga 10mg tablets had the highest increase in total costs from 2022/23 to 2023/24
Presentation name Unit of measure Total cost absolute increase (£)
Forxiga 10mg tablets tablet 89,673,001
Trelegy Ellipta 92microg/55microg/22microg/dose dry pdr inh dose 73,166,500
FreeStyle Libre 2 Sensor kit 66,062,535
Lixiana 60mg tablets tablet 53,547,034
Atorvastatin 20mg tablets tablet 37,569,197
Lixiana 30mg tablets tablet 28,997,722
Omeprazole 20mg gastro-resistant capsules capsule 23,916,237
Ezetimibe 10mg tablets tablet 21,976,145
Atorvastatin 80mg tablets tablet 19,094,417
Nitrofurantoin 100mg modified-release capsules capsule 18,632,085

Source: Additional Tables - Prescription Cost Analysis - A13

Between 2022/23 and 2023/24 the total costs of Forxiga 10mg tablets increased by £90 million, the highest absolute change of all presentations. Forxiga 10mg tablets is the proprietary version of Dapagliflozin 10mg tablets, primarily used to control blood sugar levels in people with type 2 diabetes.

Top 10 presentations by decrease in total cost 2022/23 to 2023/24

Chart
Figure 16: Apixaban 5mg tablets had the highest decrease in total costs from 2022/23 to 2023/24
Table
Table 16: Apixaban 5mg tablets had the highest decrease in total costs from 2022/23 to 2023/24
Presentation name Unit of measure Total cost absolute decrease (£)
Apixaban 5mg tablets tablet -115,768,594
Apixaban 2.5mg tablets tablet -43,632,016
Alendronic acid 70mg tablets tablet -25,501,443
Fostair 100micrograms/dose / 6micrograms/dose inhaler dose -16,476,046
Xarelto 20mg tablets tablet -15,400,660
Victoza 6mg/ml solution for injection 3ml pre-filled pens pre-filled disposable injection -13,921,136
Ranexa 375mg modified-release tablets tablet -12,134,515
Tresiba FlexTouch 100units/ml inj 3ml pre-filled pens pre-filled disposable injection -10,315,224
Trulicity 1.5mg/0.5ml solution for injection pre-filled pens pre-filled disposable injection -9,191,374
Ranexa 500mg modified-release tablets tablet -7,840,068

Source: Additional Tables - Prescription Cost Analysis - A14

Between 2022/23 and 2023/24 the total costs of Apixaban 5mg tablets decreased by £120 million, the highest absolute decrease of all presentations. Apixiban is an anticoagulant primarily used to lower the risk of blood clots developing in patients who have a condition called atrial fibrillation.

3. UK comparisons

Prescription Cost Analysis statistics are produced separately by each UK nation, and there are differences in data collection, healthcare structures, and methodology. Therefore, it’s important to be cautious when comparing PCA data of different UK nations, and to consider the broader context of the UK’s health and social care landscape.

We’ve selected some measures that enable broad comparisons between the PCA of the different devolved authorities, but for more detailed information, please refer to each country’s individual publication.

We based our comparisons on the latest available PCA data and mid-year population estimates from the Office for National Statistics (ONS), for the financial year 2022/23, using 2022 mid-year population estimates to calculate per person measures. For Wales, the data is for prescriptions issued by Welsh GPs and dispensed in Wales or other UK countries. This is because figures for wales were not available at time of publication.

Cost per person for the UK nations 2022/2023

Chart
Figure 17: England had the lowest prescription item cost per person in 2022/23
Table
Table 17: England had the lowest prescription item cost per person in 2022/23
Country Cost per person (£)
Northern Ireland 263.86
Scotland 226.80
Wales 199.49
England 182.57

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

England had the lowest prescription item cost per person in 2022/23 at £183.

Northern Ireland had the highest prescription item cost per person in 2022/23 at £264.

Items per person for the UK nations 2022/2023

Chart
Figure 18: Scotland had the fewest items dispensed per person in 2022/23
Table
Table 18: Scotland had the fewest items dispensed per person in 2022/23
Country Items per person
Wales 25.9
Northern Ireland 23.7
England 20.6
Scotland 20.3

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

There were 21 items per person dispensed in England in 2022/23.

Scotland had the fewest items dispensed per person in 2022/23 at 20.

There were 26 items per person dispensed in Wales in 2022/23.

4. About these statistics

4.1. Monthly PCA data

The NHSBSA publishes a monthly administrative management information dataset for PCA using the same methodology as these statistics. However, while our annual PCA is an Official Statistic, the monthly dataset is not.

There is a slight difference between the annual National Statistics and the monthly administrative data for PCA. The annual publication uses the geographical structure as of the 31st March for that year, while the monthly data uses the structure at the end of the month. If a dispensing contractor changes parent organisation during the year, this may affect the ICB level total in the aggregated monthly data compared to the annual National Statistics, but it will not affect the national totals. However, such cases are rare.

4.2. Uses of these statistics

These statistics serve several purposes, including:

  • providing a national overview of community prescription costs and volumes in England for the calendar year

  • analysing cost and volume trends across different 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

For this release, we have included SNOMED level data at an ICB level in the supporting tables.

Information on items dispensed via the Pharmacy First Clinical Pathway is now included in the BNF presentation level data and SNOMED level data tables of the supplementary tables.

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 is released in June of each year when March data becomes available to allow us to provide a financial year overview. Calendar year data is published in February of each year when December data becomes available on the NHSBSA Open Data Portal (ODP).

4.5. Price concessions

When community pharmacies cannot source a drug at or below the reimbursement price as set out in the Drug Tariff, the DHSC can introduce a price concession at the request of Community Pharmacy England. A price concession can be requested for any drugs listed in Part VIIIA, Part VIIIB and Part VIIID of the Drug Tariff. For any drugs granted price concessions, contractors are automatically reimbursed at the new prices for that month.

5. Rounding

The high-level figures in this statistical summary have been rounded as per the table below:

From To Round to nearest
0 1,000 1
1,001 10,000 100
10,001 100,000 1,000
100,001 1,000,000 10,000
1,000,001 10,000,000 100,000
10,000,001 100,000,000 1,000,000
100,000,001 10,000,000,000 10,000,000
10,000,000,001 100,000,000,000 100,000,000

All changes and totals are calculated prior to rounding. Percentage changes are calculated prior to rounding and then are rounded to the nearest whole number. Since all figures within this statistical summary have been rounded, they may not match totals elsewhere when aggregated.

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.

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