Prescribing Costs in Hospitals and the Community – England 2020/21

Source: NHSBSA 11/11/21



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. It is 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.

Starting with the 2020/21 release, our publication will be produced using data that reflects the actual costs paid by hospitals, including any discounts. This data is collated by Rx-Info and is accessed through their Define system. Data from this source is only available from April 2016 onwards. Primary care data will continue to be extracted from our Enterprise Data Warehouse (EDW).

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 STP
  • a view of the data down to financial year, BNF Chapter, BNF Section and STP combined

Key findings

The total expenditure on medicines in England by the NHS in 2020/21 was estimated to be £16.7 billion. The total expenditure without central rebates was £17.1 billion, an increase of 4.56% from the £16.4 billion in 2019/20. This is split down to £9.42 billion issued in primary care and dispensed in the community, £7.59 billion issued in hospitals, £87.9 million prescribed in hospitals and dispensed in the community, and £24.3 million prescribed by dentists and dispensed in the community.

  • The cost of medicines prescribed in primary care in England in 2020/21 was £9.42 billion, 55.0% of total expenditure. The cost of medicines dispensed in hospitals in England in 2020/21 was £7.59 billion, 44.3% of total expenditure.
  • In 2020/21, the BNF Chapter 8 – Malignant Disease and Immunosuppression had the highest spend across all settings of £2.80 billion, 16.3% of the total spend. Of this spend, £2.61 billion was for medicines issued and dispensed in hospitals.
  • The average costs per capita for drugs, dressing, appliances, and medical devices prescribed in England in 2020/21 across all settings was £303.

This is the first release in our new series following the migration of this publication from NHS Digital to the NHSBSA. This release uses data that reflects the actual costs (including applicable VAT) paid by hospitals for medicines including any discounts. Previous versions of this publication used the cost of medicines at list price. This did not provide an accurate estimate of the actual costs to hospitals for the provision of medicines to patients.

It is not possible to include the central rebates in the figures broken down by Sustainability and Transformation Partnership (STP) or British National Formulary (BNF) category. This is because of commercial confidentiality.

The central rebate figure includes rebates from arrangements NHS England and NHS Improvement (NHSEI) agreed with pharmaceutical companies following 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.

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