Medical exemption certificate (MedEx): conditions, FP92A form and validity

What the certificate does

A medical exemption certificate, called a MedEx, removes the £9.90 prescription charge in England for people with one of ten listed conditions. The certificate covers every item on every prescription, whatever the medicine is for. It is issued by the NHS Business Services Authority (NHSBSA) and costs nothing.

People aged 60 or over already get free prescriptions on age and do not need one.

The conditions list

The NHSBSA medical exemption page and leaflet HC11 give the same list:

• A permanent fistula, for example a caecostomy, colostomy, laryngostomy or ileostomy, needing continuous surgical dressing or an appliance.
• A form of hypoadrenalism, such as Addison's disease, for which specific substitution therapy is essential.
• Diabetes insipidus or other forms of hypopituitarism.
• Diabetes mellitus, except where treatment is by diet alone.
• Hypoparathyroidism.
• Myasthenia gravis.
• Myxoedema, meaning hypothyroidism needing thyroid hormone replacement.
• Epilepsy needing continuous anticonvulsive therapy.
• A continuing physical disability that means you cannot go out without the help of another person. Temporary disabilities do not count, even if they last several months.
• Cancer, where you are undergoing treatment for cancer, the effects of cancer or the effects of cancer treatment.

Conditions outside the list do not qualify, whatever the number of items they need. Asthma, high blood pressure, arthritis and mental health conditions are not on it. People in that position use a prepayment certificate instead.

How long it lasts

The rule changed in July 2026. For applications the NHSBSA received before 15 July 2026, a MedEx is valid for 5 years. For applications received on or after 15 July 2026, the certificate is valid for 10 years. The exception is cancer: where cancer treatment is the only qualifying condition the certificate still lasts 5 years. If you have cancer and another listed condition, the certificate runs for 10 years.

The certificate must be valid on the date you collect the prescription. It remains usable on its expiry date.

Backdating

The start date is set one month before the date the NHSBSA receives the application. The NHSBSA says it cannot change the start date of a medical exemption certificate once issued. Any charge paid inside that backdated month can be claimed back with form FP57, collected at the counter when you paid, within 3 months of payment.

How much it saves

Each item is £9.90. Someone collecting 3 items a month pays £29.70 a month at the counter, or £356.40 across 12 months. With a MedEx that cost is zero. Against the next-cheapest option, a 12-month prepayment certificate at £114.50, the MedEx still saves £114.50 a year because it has no fee.

For one item a month the saving is £118.80 a year. For two it is £237.60. Over a 10-year certificate at 3 items a month the figure reaches £3,564 at today's charge.

Steps to get one

1. Ask your GP practice for form FP92A. The practice holds the stock. The form needs the doctor's confirmation and signature, so it may take a few days to come back.
2. Fill in your part: name, date of birth, address and the condition.
3. Return the form. Many practices send it to the NHSBSA themselves. If you are given it back, post it to the address printed on the form.
4. Wait up to 10 working days from the date the NHSBSA receives the form. The certificate arrives by post.
5. Tick box E on the back of each prescription form, or confirm the exemption when the pharmacy asks for an electronic prescription. You may be asked to show the certificate. The NHSBSA says you can still collect free items if you do not have the certificate with you, as long as it was valid on the date of collection.
6. Keep any FP57 forms from charges paid in the month before the NHSBSA received your application and claim them back within 3 months.

Renewal

The NHSBSA writes to holders under 60 one month before the expiry date. Renewal means a fresh FP92A from the GP practice, confirming the condition still applies. Holders who turn 60 during the term do not need to renew because age takes over. Check the expiry date before each claim once the certificate is several years old.

Changes and replacements

A name change needs a new certificate. Return the old one with a copy of a marriage or civil partnership certificate, deed poll, passport or decree absolute. Report an address change or a printing error to the NHSBSA. A lost or damaged certificate can be replaced on request.

Mistakes that cost money

Paying £9.90 per item for years without asking. Hypothyroidism and diabetes treated with tablets are both on the list, and both involve lifelong prescriptions.

Buying a PPC when a MedEx applies. The PPC fee is refundable in proportion if a MedEx comes through during the term, so apply for the MedEx straight away and then claim the PPC refund using the rules in leaflet HC11.

Letting the certificate lapse. A claim made on an expired certificate is treated as a wrong claim and attracts a penalty of five times the charge, up to £100, plus the charge.

Claiming for a condition not on the list. Only the ten conditions above qualify. A GP cannot add others.

Where the figures come from

The conditions list, the FP92A route, the 10-working-day posting time, box E and the renewal reminder are from the NHSBSA medical exemption certificates page. The 15 July 2026 change from 5 to 10 years and the one-month backdating rule are from NHSBSA knowledge base article KA-03730. The £9.90 charge is from the NHS website and leaflet HC11. The £114.50 PPC price and PPC refund rules are from the NHSBSA PPC page and HC11. The UK-wide validity statement is from the Welsh Government free prescriptions page.