Can pharmacies charge for sourcing hard-to-find medicines?

Can a pharmacy charge extra on an NHS prescription?

No, and the rule sits at the top of the statute book. Section 1(4) of the NHS Act 2006 covers services provided as part of the health service in England. They "must be free of charge except in so far as the making and recovery of charges is expressly provided for by or under any enactment". Dispensing an NHS prescription is a health service. The only charge expressly provided for is the prescription charge.

That charge is set by regulation 3 of the NHS (Charges for Drugs and Appliances) Regulations 2015. A chemist "must, subject to paragraphs (5) to (7), make and recover from that patient" a charge of £9.90 for each quantity of a drug and each appliance. Elastic hosiery is £9.90 or £19.80 a pair. The £9.90 figure dates from 1 May 2024 and had not been amended by July 2026. Paragraph 7(3) of Schedule 4 to the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 requires you to ask about exemption before you supply. Nothing in either instrument creates a sourcing fee, a handling fee or a specials surcharge.

So the position on an NHS item is binary. If the patient is exempt, they pay nothing. If not, they pay £9.90 per item. The hours spent ringing wholesalers, the direct order from the manufacturer, the special that cost £180 to buy in: none of it can be passed to the patient. The table below sets out what you may and may not collect from an NHS patient, with the source for each.

What does the NHS pay for the sourcing effort?

Fixed fees that do not vary with the time you spent. Every NHS item earns the single activity fee, which the 2026/27 settlement announced on 29 May 2026 raised from £1.46 to £1.52, backdated to May 2026. Part IIIA of the Drug Tariff then adds fixed sums for particular supplies. The fees below are from Part IIIA as published by the NHSBSA.

The concession is the only one of those that tracks the market, and it does so a month at a time. Community Pharmacy England (CPE) published its 2026 Pharmacy Pressures Survey on 14 July 2026. It found that 60.4% of pharmacy team members supply medicines above Drug Tariff price every day. 99% of owners said reimbursement prices do not cover their costs. 75% of pharmacies reported losing money. Retrospective top-ups, paid quarterly since April 2024 where DHSC's margin survey finds a concession price was too low, soften some of that after the fact. How the mechanism works, and why it lags, is in how price concessions work and why pharmacies dispense at a loss.

The gap is now on the negotiating table. The 2026/27 settlement committed CPE and the government to a joint reform programme. CPE's summary says it will review the distribution of margin, longer-term goals for reimbursement, and "supply with reasonable promptness (which links to dispensing at a loss)". Until it reports, the NHS position stands: you must supply, you may not surcharge, and the concession system is the only relief.

Can you charge a sourcing fee on private prescriptions?

Yes. A private prescription is a contract between the pharmacy and the patient, and no statute sets or caps the price. You can charge for the medicine at whatever margin you choose. You can add a dispensing fee, and a sourcing or specials fee for the work of finding a hard-to-get item. The medicines law is the same on both sides. Regulation 214 of the Human Medicines Regulations 2012 still requires supply in accordance with the prescription. An SSP covers a private prescription unless it says otherwise. The pricing law is different.

Three consumer-law rules shape the fee. First, price information. Schedule 2 to the Consumer Contracts (Information, Cancellation and Additional Charges) Regulations 2013 applies before a distance or off-premises contract is made. The trader must give "the total price of the goods, services or digital content inclusive of taxes". Where the price cannot reasonably be calculated in advance, it must give "the manner in which the price is to be calculated". It also requires "all additional delivery charges and any other costs", or the fact that such charges may be payable. For an online pharmacy, that is every order.

Second, express consent. Regulation 40 of the same Regulations is blunt. "No payment is payable in addition to the remuneration agreed for the trader's main obligation unless, before the consumer became bound by the contract, the trader obtained the consumer's express consent." Consent "inferred from the consumer not changing a default option (such as a pre-ticked box on a website)" does not count. If you take an extra payment without that consent, the contract "is to be treated as providing for the trader to reimburse the payment". A sourcing fee added at checkout without an active opt-in is refundable on demand.

Third, the headline price. Section 230 of the Digital Markets, Competition and Consumers Act 2024, in force since 6 April 2025, treats the total price as material information in any invitation to purchase. Under section 230(4), the total price "includes any fees, taxes, charges or other payments that the consumer will necessarily incur if the consumer purchases the product". A sourcing fee that every buyer of a listed special must pay belongs in the advertised price, not in a footnote. A fee that applies only to some orders must be flagged before the patient commits, with the way it is calculated.

How are specials priced?

Differently on each side of the counter. On the NHS, CPE's guidance on unlicensed specials sets out three routes. A special listed in Part VIIIB of the Drug Tariff, mostly liquids, creams and ointments, is reimbursed at a price per unit above a minimum quantity. Prices are updated in February, May, August and November. A special in Part VIIID, mostly unlicensed tablets and capsules, is reimbursed by reference to listed pack sizes, and broken bulk may be claimed. A special or import not listed in the Tariff is reimbursed at the invoice price, less any discount or rebate, with no discount deducted and no out-of-pocket expenses. Each earns the £20 unlicensed medicine fee, and each must be endorsed "SP".

The endorsement and records matter because the reimbursement depends on them. For a non-Tariff special you endorse the quantity, the pack size, the price per unit after discount, the manufacturer's or importer's MHRA licence number and the batch number. You keep the source, the supply date, the recipient, the prescriber, the quantity, the batch number and any certificate of analysis or conformity for five years. On EPS the prescriber must write "Special Order", "Drug Tariff special order" or "Import (country)" in the prescribing line. None of that cost reaches the patient; they pay the prescription charge or nothing.

Privately, the pharmacy sets the price. In practice that is the specials manufacturer's price, which can vary widely between suppliers for the same formulation, plus a fee. The fee covers the professional work: checking that no licensed alternative exists and that the source holds an MHRA licence. MHRA Guidance Note 14 sets the order of preference: a licensed product first, then an import of a product licensed elsewhere, then a UK special. Quote the price before ordering, because a bespoke special usually cannot be returned once made. How to price a pharmacy catalogue covers the margin arithmetic for private lines.

Do patients have to be told about sourcing fees?

Yes, before they commit, and in a form they can keep. For a private prescription handed over the counter, that means a quoted price and fee before you place the order. For an online pharmacy or a prescription taken by phone, the Consumer Contracts Regulations require the price information in a durable form. The fee needs an active tick, not a pre-ticked box. The practical test is simple: could the patient have walked away knowing the full cost? If not, the fee is at risk.

Refunds on the medicine itself follow different rules, and a made-to-order special sits in a category of its own. See whether customers have a right to refunds on medicines. If you are building the private side from scratch, the pricing and consent steps fit into a private prescription workflow.

Can a pharmacy refuse to source an unavailable medicine?

Not on the NHS just because it is hard to get. Paragraph 5(2) of Schedule 4 to the 2013 Regulations requires an NHS pharmacist, once a prescription is presented, to "provide the drugs so ordered" with reasonable promptness. Paragraph 9(1) lists when you may refuse. The grounds are a prescription you reasonably believe is stolen or forged, and an apparent error or a supply against the pharmacist's clinical judgement. They also cover violence or threats against staff, a criminal offence committed or threatened, and a prescription missing the prescriber identification NHS England requires. Difficulty of supply is not there.

Two provisions give some room. Paragraph 9(2C) applies where a Serious Shortage Protocol covers the item. It lets you refuse the prescribed item if the pharmacist judges the SSP alternative unreasonable or inappropriate and you cannot supply the original in a reasonable timescale. And paragraph 7 lets "reasonable promptness" absorb a wait, provided you give an estimated time when asked and a revised one if it slips. What you cannot do is send the patient away because the item is not in stock, or condition the supply on a payment. The lawful options are to owe, to signpost to a pharmacy that has it, to use an SSP, or to get the prescription changed. The routine for that is in how to run a shortages workflow.

Privately, there is no duty to accept the prescription at all. A pharmacy can decline private work it cannot source at a reasonable price or in a reasonable time. Two cautions apply. Apply the same policy to every patient, so that a refusal cannot be read as discrimination. And tell the patient promptly, so they can go elsewhere before they run out.

How do you stay compliant?

With one written policy and two price lists. The policy states that NHS items carry the prescription charge only, that private items carry the published fees, and who may vary either. The NHS list is the Drug Tariff. The private list is yours, and it should show the dispensing fee, the sourcing fee, the specials fee and the trigger for each. Train the counter team to quote from it and to record the patient's agreement before an order goes in.

Then audit it. Once a quarter, pull every private item that carried a sourcing fee and check three things. The quote was given before the order. The consent is recorded. The receipt itemises the fee. Pull every NHS special and check the endorsement and the £20 fee were claimed, because that fee, not the patient, is where the sourcing effort is paid. And check the concession reports went in, because a month with unreported above-Tariff purchases is a month of margin nobody will refund.

Key takeaways

FAQs