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Prescribing Costs in Hospitals and the Community - England 2021/22

Published 10 November 2022


This publication aims to explore the costs of medicines prescribed within both primary and secondary care in England.

This publication is an experimental Official Statistic release. Its produced in line with the standards set out in the Code of Practice for Statistics. Later consideration of this release for National Statistic designation by the Office of Statistical Regulation (OSR) is planned.

The statistics in this publication 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

We’ve included the Actual Cost for prescription items dispensed in the community at national level. This has been done to provide a more accurate measure of the total cost to NHS commissioners for the provision of medicines, appliances, and medical devices in England. Definitions of the different cost measures presented in these statistics can be found in the statistical summary narrative and the background and methodology note.

In July 2022, ICBs replaced Sustainability and Transformation Plans (STPs) as legal entities within the NHS. These statistics have been presented with the latest NHS organisational structure, including historical data to allow easier comparisons to be made across the time period. Users should always use the latest statistics available when carrying out any analysis.

Key findings

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 2021/22 is estimated to be £17.2 billion. This includes a deduction of £619 million for central rebates. The total cost without central rebates was £17.8 billion, an increase of 8.32% from £16.4 billion in 2020/21.

In 2021/22, the cost to NHS commissioners in England for medicines:

  • prescribed in primary care and dispensed in the community was £8.90 billion, 50.0% of total expenditure
  • issued in hospitals was £8.77 billion, 49.3% of total expenditure
  • prescribed in hospitals and dispensed in the community was £85.1 million
  • prescribed by dentists and dispensed in the community was £29.3 million

In 2021/22, the BNF Chapter 8 – Malignant Disease and Immunosuppression had the highest spend across all settings. The spend for Chapter 8 was £3.11 billion when using Net Ingredient Cost (NIC) for items dispensed in the community, 16.9% of the total spend. Of this spend, £2.95 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 2021/22 across all settings was £324. This is an increase from £301 in 2020/21. 

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 NHS England and Improvement (NHSEI) have agreed with pharmaceutical companies. These rebates follow 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.

Resource list

Prescribing Costs in Hospitals and the Community England 2021/22 - Statistical Summary Narrative (HTML)

Supporting summary tables (Excel: 3.28MB)

Background information and methodology note (HTML)

User engagement strategy (ODT: 228KB)

Pre-release access list (ODT: 219KB)


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Responsible statistician: Graham Platten