Prescriptions

People medically diagnosed with coeliac disease are entitled to receive gluten-free foods on prescription. The amount and type of foods that are prescribed is at the discretion of the prescriber. With no guidelines from the Department of Health on how much gluten-free food is adequate the amounts that people with coeliac disease receive is very variable.

Adherence to a gluten-free diet is improved when adequate supplies of staple foods such as gluten-free bread, pasta and flour can be obtained . A survey conducted by Coeliac UK in 2002 found that over 90% of people with coeliac disease obtained their gluten-free food on prescription. It is therefore essential that prescribers are aware of adequate amounts and types of foods that they should be prescribing for their patients.

What is available?

There are a wide number of foods available on prescription made by a number of manufacturers. Foods available are bread, bread/cake/flour mixes, pizza bases, plain sweet biscuits, plain crackers and pasta. Luxury items such as chocolate biscuits are not available on prescription but can be purchased from supermarkets or health food stores. The most commonly prescribed foods are bread, plain biscuits and flour mixes. A list of prescribable gluten-free foods can be found in MIMS, the BNF, the Drug Tariff, Coeliac UK's Food and Drink Directory and by clicking prescribable list

Due to the wide variety and taste of foods available it is advisable for patients to try a variety before setting up a repeat prescription. Sample packs are offered by some of the manufacturers, so that patients can try their products before deciding on which they want to receive on a regular basis.

How much to prescribe

Prescribing guidelines have been produced to aid healthcare professionals involved in the prescribing process, based on:

• Consumption data from the National Diet and Nutrition Surveys (1)
• The Balance of Good Health model
• Gluten-free prescribable foods providing 15% total energy (total CHO should provide 50% total energy which includes naturally gluten-free foods such as rice potatoes and breakfast cereals, intrinsic and milk sugars as well as gluten-free prescribable foods)  

The guidelines provide a minimum monthly amount of gluten-free food, calculated in units, based on requirements of different ages and sexes. Gluten-free foods have been given a unit value (see tables below). Additional amounts are added for high activity levels, breastfeeding and 3rd trimester of pregnancy.

Example:

Male aged 15-59 years requires 18 units per month.
This could be made up of:

• 10 x 400g loaves of bread (=10 units)
• 1 x 2 pack pizza bases (=1 unit)
• 1 x 500g pasta (=2 units)
• 2 x 200g crackers (=2 units)
• 1 x 200g sweet biscuits (=1 unit)
• 1 x 500g flour mix (=2 units)

A free copy of gluten-free foods: a prescribing guide can be obtained by clicking here. Coeliac UK has produced a leaflet explaining prescriptions for patients.

Cost of prescriptions

People with coeliac disease in England, Scotland and Northern Ireland do not receive prescriptions free of charge, unless they are exempt for another reason. Prescriptions in Wales are free of charge.

Patients will usually need to pay a separate prescription charge for each item of gluten-free food.

Currently the prescription charge is £6.85; this is to increase to £7.10 from 1st April 2008.

In Scotland, the prescription charge is reduced from April 1st 2008 to £5 and will be reduced further every year until 1st April 2011- from this date prescriptions will be free of charge.

Patients who have to pay for more than 3 prescription items in 3 months, or 14 items in 12 months could save money by buying a pre-payment certificate (PPC). A PPC covers the cost of all items on prescriptions (including medications). 
 
Current pre-payment certificate costs and forms can be obtained from a pharmacy or from the Department of Health website.

Criteria for exemption

People who fall into the following categories are entitled to free prescriptions:

• Children under 16
• Students under 19 and in full-time education (the place of study must be registered with the Department for Education and Skills)
• Adults over 60
  
  People in receipt of the following benefits:
• Income Support
• Pension Credit Guarantee Credit
• Income-based Jobseekers Allowance
• Working Families Tax credit reduced by £70 or less
• Disabled Persons Tax Credit reduced by £70 or less
  
  People who have one of the following:
• Tax credit NHS Exemption Certificate
• Maternity Exemption Certificate (for expectant mothers or if you have given birth in the last 12 months)
• Medical Exemption Certificate
• Valid War Pensioner Exemption Certificate (and the prescription is for your accepted disablement)
• HC2 or HC3 Certificate - you may qualify for help if you have a low income.

Students who are 19 years of age and over should be encouraged to see if they are entitled to free prescriptions or help towards prescription costs under the NHS Low Income Scheme. To apply for help under the scheme, people need to complete an HC1 form which is available from a local students' union, some dentists and opticians, GP surgeries or requested online where it will be posted out.

References

1The National Diet & Nutrition Survey: adults aged 19 to 64 years.
Types and quantities of foods consumed. A survey carried out in Great Britain on behalf of the Food Standards Agency and the Departments of Health by the Social Survey Division of the Office for National Statistics
and Medical Research Council Human Nutrition Research. 2002