Over the counter vs prescription: which costs less in England

The rule that sets the price

An NHS prescription in England costs £9.90 for each item on it. A medicine on the shelf is cheaper whenever its price is below £9.90. For many minor conditions you buy the medicine anyway, because NHS England asks GPs not to prescribe it routinely.

Scotland and Wales have no prescription charge, so the comparison there is a free prescription against the shelf price. This page deals with England.

NHS England's list of 35 conditions

NHS England's policy guidance names 35 conditions for which GPs should not routinely prescribe over the counter items. It also lists probiotics, and vitamins and minerals, as items of limited clinical effectiveness.

Eight conditions are self-limiting: acute sore throat, infrequent cold sores of the lip, conjunctivitis, coughs, colds and nasal congestion, cradle cap, haemorrhoids, infant colic and mild cystitis.

Twenty-seven are minor conditions suitable for self-care: mild irritant dermatitis, dandruff, diarrhoea, dry or sore tired eyes, earwax, excessive sweating, head lice, indigestion and heartburn, infrequent constipation, infrequent migraine, insect bites and stings, mild acne, mild dry skin, mild to moderate hay fever, minor burns and scalds, minor pain, discomfort or fever, mouth ulcers, nappy rash, oral thrush, prevention of dental caries, ringworm or athlete's foot, sunburn, sun protection, teething or mild toothache, threadworms, travel sickness, and warts and verrucae.

The guidance keeps room for a prescription. Exceptions include a long-term condition, a more complex form of a minor illness, red flag symptoms, a minor condition which has not responded to an over the counter product, and patients whose ability to self-care is compromised by medical, mental health or significant social vulnerability. Product licence limits, for example for babies or during pregnancy, are another exception. Being exempt from prescription charges is not one. The guidance says exemption does not automatically warrant an exception.

When buying costs less than £9.90

Prices on 22 October 2026, against the English charge of £9.90 an item:

Superdrug (GPhC 9010126 for its online pharmacy) sells the 32-caplet paracetamol pack as a pharmacy medicine. You answer a questionnaire, a pharmacist checks it, and the product was listed for store collection only. Tesco showed the Canesten cream as out of stock.

The clotrimazole pair shows why price per gram matters. The branded Canesten tube cost £200 per kg against £225 per kg for the Care tube, so the brand was the cheaper buy here.

When the prescription costs less

A prescription wins when the medicine costs more than £9.90 or you need it every month.

Repeat treatment is the clearest case. Tesco's esomeprazole pack holds 14 capsules, and its label says to contact your doctor if symptoms do not improve after 14 days in a row. Two packs cost £18.00. A month of omeprazole 20 mg on a private prescription cost £16.00 for 28 at Superdrug Online Doctor, which dispenses from Superdrug Pharmacy in Northampton (GPhC 9010736). If your GP prescribes omeprazole for an ongoing condition, the NHS charge is £9.90 an item.

Higher strengths and larger quantities follow the same logic. The charge is per item, so a large pack or a strong dose on one item costs the same £9.90 as a small one.

Products priced above £9.90 are not always prescribable. Hedrin at £15.29 treats head lice, which sits on NHS England's self-care list, so a GP is unlikely to prescribe it unless an exception applies.

Prepayment certificates and exemptions

A prescription prepayment certificate covers all your NHS prescriptions for a fixed fee: £32.05 for 3 months or £114.50 for 12 months, which you can spread over 10 monthly direct debits. Once you hold one, every extra NHS item costs nothing. Over the counter purchases fall outside it. Use the prepayment certificate calculator to check whether one pays for itself.

If you are exempt, NHS items are free, but the self-care guidance still applies. For a minor condition on the list you buy the product like anyone else, unless one of the exceptions fits. The free prescriptions page lists who is exempt.

A free pharmacy option

In England, Pharmacy First covers seven conditions with NHS medicine from the pharmacist. In Wales the Common Ailments Service gives a free consultation and free medication for 28 conditions, several of them on NHS England's list, including athlete's foot, diarrhoea, head lice and threadworm.

Steps to decide

1. Check whether the condition is on NHS England's list of 35.
2. Price the shelf product and compare it with £9.90.
3. For a long-term condition, or one an over the counter product has not helped, ask your GP about a prescription.
4. If you collect several NHS items a year, compare the £114.50 certificate with paying £9.90 each time.
5. Ask the pharmacist about pack sizes and strengths before buying.

Mistakes that cost money

Booking a GP appointment for a medicine costing under £1 on the shelf.

Buying a dearer product month after month when a long-term condition qualifies for an NHS prescription.

Assuming an exemption certificate means the GP must prescribe shelf items. The guidance says it does not.

Comparing pack prices instead of price per gram or per tablet.

Where the figures come from

The 35 conditions, the categories and the exceptions are from NHS England's policy guidance on over the counter items. The £9.90 per item rule is from the NHS website, and the certificate prices and direct debit option from the NHSBSA. The Common Ailments Service is from NHS 111 Wales, and the Scottish and Welsh prescription rules from the Scottish and Welsh Governments. Shelf prices are from the Tesco and Superdrug product pages listed in the sources, and the omeprazole price from Superdrug Online Doctor, all read on 22 October 2026.