England 2022/23
Published 9 November 2023
Changes to these statistics
We have made changes to include data on medicines prescribed and
dispensed in the Adult Secure Estate. Medicine prescribed and dispensed
in the Adult Secure Estate data is the aggregate spend on medicines
dispensed to patients in adult prisons and detention centres. Health
services to patients who are in prison or detention are supplied under
contract commissioned by NHS England Specialised Commissioning
Directorate. A breakdown of spend by BNF chapter is not currently
available.
We are interested in any feedback about the
publication, which you can send by using our
Official
Statistics feedback survey.
Key findings in 2022/23
£18.5 billion was the total cost to NHS commissioners in England, for the issue of medicines, appliances, and medical devices.
£3.3 billion was spent on medications in BNF Chapter 8 – Malignant Disease and Immunosuppression.
50% (£9.6 billion) of total expenditure was for medications prescribed in primary care and dispensed in the community.
The total cost to NHS commissioners (known as actual cost in primary care data) in England, for the issue of medicines, appliances, and medical devices in 2022/23 is estimated to be £18.5 billion. This includes a deduction of £674 million for central rebates. The total cost without central rebates was £19.2 billion, an increase of 7.99% from £17.8 billion in 2021/22.
In 2022/23, the cost to NHS commissioners in England for medicines:
- prescribed in primary care and dispensed in the community was £9.59 billion, 50.0% of total expenditure
- issued in hospitals was £9.45 billion, 49.2% of total expenditure
- prescribed in hospitals and dispensed in the community was £93.6 million
- prescribed by dentists and dispensed in the community was £32.4 million
- prescribed and dispensed in the Adult Secure Estate was £24.9 million
In 2022/23, the BNF Chapter 8 – Malignant Disease and Immunosuppression had the highest spend across all settings of £3.26 billion when using Net Ingredient Cost (NIC) for items dispensed in the community, 16.4% of the total spend. Of this spend, £3.09 billion was for medicines issued and dispensed in hospitals.
The average costs per capita when using NIC for items dispensed in the community for medicines, appliances, and medical devices prescribed in England in 2022/23 across all settings was £349. This is an increase from £324 in 2021/22.
1. Things you should know
1.1 Scope
These statistics cover NHS prescriptions and medicines issued in England. This includes:
prescriptions issued by GP practices and community prescribers in England that have been dispensed in the community in the UK (excluding Northern Ireland)
prescriptions issued by hospitals in England that have been dispensed in the community in the UK (excluding Northern Ireland)
prescriptions issued by dental practitioners that have been dispensed in the community in the UK (excluding Northern Ireland)
medicines issued in hospitals in England that have been dispensed via the hospital pharmacy, homecare companies and outsourced outpatient pharmacy partnerships
medicines prescribed and dispensed in the Adult Secure Estate
But excludes:
prescriptions issued through Armed Services health services in England commissioned by NHS England (NHSE) but not dispensed in the community – this covers pharmacy, appliances, Dispensing Doctors (DD) and Personally Administered Items (PADM)
any medicines issued in hospitals in England but not managed via the hospital pharmacy service
dressings and devices issued in secondary care as supply of these is usually made via the NHS Supply Chain
This publication aims to explore the costs of medicines prescribed within both primary and secondary care in England. These statistics detail:
cost breakdowns by financial year and month within each setting
cost breakdowns by BNF Chapter and BNF Section level by financial year and setting
financial year cost breakdowns in each setting by Integrated Care Board (ICB)
a view of the data down to financial year, BNF Chapter, BNF Section and ICB combined
1.2 Data sources
Data for this publication is collated from 2 sources. Rx-Info collect data from hospital pharmacy systems including the actual costs paid with discounts. This data is accessed and extracted using the Define system operated by Rx-Info. The data used for this publication was extracted on 12 September 2023. Data is available from April 2018 onwards.
Data for prescription items dispensed in the community are taken from the NHSBSA Enterprise Data Warehouse and contain 2 different cost measures, Net Ingredient Cost (NIC) and Actual Cost, full definitions for these measures can be found in section 1.3 – Definitions. Actual Cost has been included in these statistics alongside NIC at a national level to give a more accurate measure of the total cost to NHS commissioners for the prescribing of medicines, appliances, and medical devices.
For breakdowns below national totals, such as ICB or BNF section, NIC has been used for prescription items dispensed in the community due to limitations of Actual Cost and how it is calculated.
Data for Central Rebates is provided by the Commercial Medicines Unit, a part of NHSEI. It is not possible to include the central rebates in the figures broken down by ICB or BNF category owing to commercial confidentiality. The central rebate figure includes rebates from arrangements NHSEI have agreed with pharmaceutical companies following successful negotiations to commission a variety of treatments both in the cancer drugs fund (CDF) and in routine commissioning. This includes treatments for both rare diseases and more common conditions.
1.3 Definitions
Hospital Costs
Throughout this publication when ‘costs’ are referred to within hospitals they are the actual costs paid (including applicable VAT) for medicines, appliances, and medical devices which have been issued in NHS hospitals in England by the hospital pharmacy, following any discount.
Actual Cost
For prescription items dispensed in the community, Actual Cost is the
cost recharged to NHS commissioners for the provision of drugs,
appliances, and medical devices by dispensing contractors. It is
calculated as the basic price of a product (Net Ingredient Cost) less
the national average discount percentage (NADP) plus payments for
consumables, out of pocket expenses (OOPE), and payments for containers:
Actual Cost = NIC * (1 – NADP) + payments for consumables +
OOPE + payment for containers
Actual cost is not reflective
of the payment made to a dispensing contractor for the cost of the
individual drugs dispensed and excludes other fees paid that a
prescription item may attract.
National Average Discount Percentage (NADP)
The NADP is calculated using the discount rates applied to individual dispensing contractors according to the Drug Tariff for England and Wales for Pharmacy and Appliance contractors and the General Medical Services Statement of Financial Entitlement Annex G Part 1 for Dispensing Doctors and Personal Administration accounts.
Net Ingredient Cost (NIC)
Net Ingredient Cost (NIC) for prescription items dispensed in the community is the basic price given either in the Drug Tariff or is determined from prices published by manufacturers, wholesalers, or suppliers. Basic price is set out in Parts VIII and IX of the Drug Tariff. For any drugs not in Part VIII, the price is usually taken from the manufacturer, wholesaler or supplier of the product. This basic price also includes retained margin, where applicable. This retained medicine margin contributes to the provision of pharmaceutical services alongside the other agreed fees and allowances.
Medicine prescribed and dispensed in the Adult Secure Estate
Medicine prescribed and dispensed in the Adult Secure Estate data is the aggregate spend on medicines dispensed to patients in adult prisons and detention centres.
British National Formulary (BNF)
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.
Integrated Care Board (ICB)
ICBs are statutory organisations responsible for bringing the NHS together locally to improve population health and establish shared strategic priorities within the NHS. They took over the functions of Sustainability and Transformation Partnerships (STPs) in July 2022.
Item
Prescribing volumes are not included in this publication. Unlike in the primary care dataset, where item level data is available, in secondary care, data is collated as quantities issued. The concept of a prescription item does not exist for secondary care medicines data.
2. Results and commentary
The charts in this report are interactive and allow you to isolate the topics that you are interested in by selecting or deselecting a series from the legend of the chart. For example, if you only want to view a single series on a chart, you can click the series names you are not interested in within the legend of the chart. This will remove the item from the charts. If you wish to subsequently include them, just click their legend entry again.
2.1 Costs by setting
Total costs by setting between 2018/2019 and 2022/2023
Actual Cost
Figure 1: This figure uses actual costs for both items dispensed in the community and those issued in hospitals.
Source: Summary Tables - Prescribing Costs in Hospitals and the Community - Table One
The actual cost of items prescribed in primary care in England in 2022/23 was £9.6 billion, 50% of total expenditure.
The cost of medicines issued in hospitals in England in 2022/23 was £9.4 billion, 49% of total expenditure.
The actual cost of items prescribed in primary care in England in 2022/23 was £9.59 billion, 50.0% of total expenditure. In 2018/19 the actual cost of items prescribed in primary care in England was £8.05 billion, 53.6% of total expenditure. The actual cost of items prescribed in primary care has been gradually increasing since 2018/19.
The cost of medicines issued in hospitals in England in 2022/23 was £9.45 billion, 49.3% of total expenditure. In 2018/19 the cost of medicines issued in hospitals in England was £6.84 billion, 45.5% of total expenditure. The cost of medicines issued in hospitals has also been gradually increasing since 2018/19.
NIC
Figure 2: This figure uses Net Ingredient Costs (NIC) for items dispensed in the community and actual costs for those issued in hospitals.
Source: Summary Tables - Prescribing Costs in Hospitals and the Community - Table Two
The NIC of items prescribed in primary care in England in 2022/23 was £10.2 billion, 52% of total expenditure.
The cost of medicines issued in hospitals in England in 2022/23 was £9.4 billion, 48% of total expenditure.
The NIC of items prescribed in primary care in England in 2022/23 was £10.2 billion, 51.5% of total expenditure. In 2018/19 the NIC of items prescribed in primary care in England was £8.63 billion, 55.3% of total expenditure. The NIC cost of items prescribed in primary care has been gradually increasing since 2018/19.
The cost of medicines issued in hospitals in England in 2022/23 was £9.45 billion, 47.7% of total expenditure. In 2018/19 the cost of medicines issued in hospitals in England was £6.84 billion, 43.8% of total expenditure. The cost of medicines issued in hospitals has also been gradually increasing since 2018/19.
Figure 3: Percentage change in costs from previous financial year by setting between 2018/2019 and 2022/2023
These figures use Net Ingredient Costs (NIC) for items dispensed in the community and actual costs for those issued in hospitals.
Source: Summary Tables - Prescribing Costs in Hospitals and the Community - Table Three
The cost of items within primary care in the community in England in 2022/23 increased 8% from 2021/22.
The cost of items dispensed in hospitals in England in 2022/23 increased 8% from 2021/22.
The total costs in England in 2022/23 increased 8% from 2021/22.
The cost of items within primary care in the community in England in 2022/23 was £10.2 billion. This was a 7.58% increase of £719 million from £9.49 billion in 2021/22 and a 18.3% increase of £1.58 billion from £8.63 billion in 2018/19.
The cost of items dispensed in hospitals in England in 2022/23 was £9.45 billion. This was an 8.09% increase of £707 million from £8.74 billion in 2021/22 and a 38.2% increase of £2.61 billion from £6.84 billion in 2018/19.
In 2022/23 the total costs paid for drugs, dressing, appliances, and medical devices was £19.8 billion. This was a 7.84% increase of £1.44 billion from the £18.4 billion paid in 2021/22 and a 27.0% increase of £4.21 billion from the £15.6 billion paid in 2018/19.
Figure 4: Total costs by setting between April 2018 and March 2023
These figures use Net Ingredient Costs (NIC) for items dispensed in the community and actual costs for those issued in hospitals.
Source: Summary Tables - Prescribing Costs in Hospitals and the Community - Table Four
£1.6 billion was the average monthly cost in England in 2022/23
£936 million was the total cost of items within primary care in the community in March 2023.
£884 million was the total cost for items issued in NHS hospitals in March 2023.
In 2022/23 the average monthly cost paid for drugs, dressing, appliances, and medical devices in England was £1.65 billion, this has increased from £1.30 billion which was the average monthly cost in 2018/19.
In March 2023, the total costs paid for medicines, appliances, and medical devices which have been issued in NHS hospitals in England was £884 million. This in an increase of 9.40% on the £808 million paid in March 2022 and an increase of 52.7% on the £579 million paid in March 2019.
In March 2023, the total cost of items within primary care in the community in England was £936 million. This in an increase of 14.0% on the £822 million paid in March 2022 and an increase of 30.0% on the £721 million paid in March 2019.
2.2 Costs by BNF Chapter
Figure 5: Total costs by BNF Chapter in the 2022/2023 financial year
These figures use Net Ingredient Costs (NIC) for items dispensed in the community and actual costs for those issued in hospitals.
Source: Summary Tables - Prescribing Costs in Hospitals and the Community - Table Five
£3.1 billion was the total cost for medicines in chapter 8 - Malignant Disease and Immunosuppression issued in hospitals.
£1.8 billion was the total cost for medicines within primary care in the community in 2022/23 for chapter 6 - Endocrine System.
£377 million is not accounted for under any of the BNF Chapters within hospitals in 2022/23.
In 2022/23 the largest single spend for a BNF Chapter in any setting was for medicines in chapter 8 - Malignant Disease and Immunosuppression issued in hospitals at £3.09 billion. This represents 32.7% of the total spend within hospitals. This is also the BNF Chapter with the highest costs across all combined settings in 2022/23 at £3.26 billion, 16.4% of the total spend of £19.8 billion.
Within primary care in the community in 2022/23 chapter 6 - Endocrine System accounted for the largest spend at £1.77 billion. This was 17.3% of the total costs in primary care prescribing dispensed in the community.
Within hospitals in 2022/23 there was a spend of £377 million which is not accounted for under any of the BNF Chapters. These are drugs manufactured as specials, dressings, appliances, and medical devices which are not authored on the Dictionary of Medicines and Devices (dm+d).
Figure 6: Top 10 BNF Sections by spend across all settings in the 2022/2023 financial year
These figures use Net Ingredient Costs (NIC) for items dispensed in the community and actual costs for those issued in hospitals.
Source: Summary Tables - Prescribing Costs in Hospitals and the Community - Table Six
£2.2 billion was the total spend in hospitals for section 0801 - Cytotoxic Drugs.
£1.4 billion was the total spend in primary care dispensed in the community for section 0601 - Drugs Used in Diabetes.
In 2022/23 the largest single spend for a BNF Section in any setting was for medicines in section 0801 - Cytotoxic Drugs issued in hospitals at £2.17 billion. This represents 23.0% of the total spend within hospitals.
Within primary care in the community in 2022/23 section 0601 - Drugs Used in Diabetes accounted for the largest spend at £1.37 billion. This was 13.5% of the total net ingredient costs in primary care prescribing dispensed in the community.
2.3 Costs by ICB
Figure 7: Total costs by ICB in the 2022/2023 financial year
These figures use Net Ingredient Costs (NIC) for items dispensed in the community and actual costs for those issued in hospitals.
Source: Summary Tables - Prescribing Costs in Hospitals and the Community - Table Seven
£1.2 billion was the largest spend across all ICB settings in 2022/23, for Greater Manchester ICB.
£42.1 million were not able to be mapped to an ICB in 2022/23.
NHS Greater Manchester was the ICB with the highest costs across all settings of £1.21 billion in 2022/23.
Data under the ‘Undefined’ ICB relate to costs in both the primary and secondary care datasets which we have been unable to map to an ICB. In 2022/23 this accounted for £42.1 million.
Data around dental in the community has not been included in figure 7 as dental data is captured under a national code and not available at ICB level.
ICB costs in secondary care are based on the ICB in which the hospital is located. Not all spend is specifically for that ICB (for example, patients may be referred to a hospital outside of their usual ICB of residence).
Figure 8: Average costs per capita by ICB in the 2022/2023 financial year
These figures use Net Ingredient Costs (NIC) for items dispensed in the community and actual costs for those issued in hospitals.
Source: Summary Tables - Prescribing Costs in Hospitals and the Community - Table Seven
£349 was the average cost per capita for medicines issued in all settings in England in 2022/23.
£554 was the highest cost per capita for NHS North Central London ICB.
£242 was the lowest cost per capita for NHS Hertfordshire and West Essex ICB.
The average cost per capita for medicines issued in all settings in England in 2022/23 was £349. This is an increase from £324 in 2021/22 and an increase from £275 in 2018/19.
NHS North Central London was the ICB with the largest average per capita costs in 2022/23 at £554. NHS Hertfordshire and West Essex was the lowest at £242.
3. Changes to this publication
For full details of the changes made please refer to the Background Information and Methodology note released alongside these statistics.
The NHSBSA has worked with the DHSC to improve the categorisation of Nutritional Borderline Substance (NBS) products. It is part of a system-wide move towards interoperability. As part of the recategorisation work for NBS some data may appear against historical BNF codes. You can find out more about this project including a list of the BNF code changes carried out on our website.
This publication now includes figures on medicines prescribed and dispensed in the Adult Secure Estate. A breakdown of spend by BNF chapter is not currently available.
4. About these statistics
4.1 Uses of these statistics
These statistics have a variety of uses including:
obtaining a national view of costs for prescriptions dispensed in hospitals and the community in England across the financial year
analysis of cost trends by BNF Chapter, BNF Section and ICB
allowing public scrutiny of national prescribing habits
4.2 British National Formulary (BNF)
The primary care data used in this publication comes from the NHSBSA Enterprise Data Warehouse (EDW). This includes the split of the data down to BNF Section. The data for secondary care is provided by Rx-Info. Rx-Info use an extract from the dm+d to obtain BNF classifications.
4.3 Time periods reported in this publication
From the 2021/22 publication onward the starting point has switched to April 2017. Secondary care data provided by Rx-Info is only available back to this point. As the RX-Info Define database only holds data from up to 5 years ago, this publication will present a rolling 5 year timescale.
4.4 Geographies included in this publication
Integrated Care Boards (ICB) 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 primary care data the ICB geographies shown use NHSBSA administrative records, not geographical boundaries, and more closely reflect the operational organisation of prescribing organisations than other geographical data sources. Within the secondary care data ICB is provided by Rx-Info who use the NHS Digital Organisation Data Service (ODS) as their source.
4.5 Population statistics included in this publication
Populations by ICB throughout this report are the same for each year and come from the latest ONS population estimates.
4.6 Measures of average
Per capita costs measure the average costs across all settings per person in a given area (England, ICB) in the specified year. It is calculated by dividing the area’s total costs by its total population.
4.7 Planned changes to this publication
This is an experimental official statistic release. Experimental statistics are newly developed or innovative statistics. These are published so that users and stakeholders can be involved in the assessment of their suitability and quality at an early stage. More information on how users can give us their feedback can be found in section 6 of this summary. We will regularly be reviewing the methodology used within the statistics.
4.8 Monthly SCMD data
NHSBSA Information Services also release a monthly data set for Secondary Care Medicines Data via the Open Data Portal (ODP). The ODP is the platform where we host our open data products. The monthly data set is produced from data provided by Rx-Info. This data includes indicative costs rather than actual costs, these are derived from current medicines pricing data held in NHSBSA data systems including the Common Drug Reference (CDR) database and dm+d calculated to a Virtual Medicinal Product (VMP) level.
4.9 Adult Secure Estate data
Medicine prescribed and dispensed in the Adult Secure Estate data is the aggregate spend on medicines dispensed to patients in adult prisons and detention centres. Health services to patients who are in prison or detention are supplied under contract commissioned by NHS England Specialised Commissioning Directorate. A breakdown of spend by BNF chapter is not currently available.
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6. Feedback and contact us
We invited feedback on the changes made to the Prescribing Costs in Hospitals and the Community Official Statistics publication, including the change of data source. The consultation took place between 15 November 2021 and 4 February 2022. You can find details of this consultation on our website.
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