(also referred to as Graves' Disease, an autoimmune disorder) myxoedema which occurs in hypothyroidism, or hyperthyroidism hypoparathyroidism diabetes insipidus or hypopituitarism Addison's disease and other forms of hypoadrenalism myasthenia gravis any continuing physical disability which stops them going out alone undergoing treatment for cancer, including the effects of cancer, or the effects of current or previous cancer treatment Medical Exemption Certificates last for five years, and are not applicable to NHS wigs or fabric supports. Medicines administered at an NHS hospital or an NHS walk-in centre, personally administered by a GP, contraceptives or supplied at a hospital or clinic for the treatment of a sexually transmitted infection or tuberculosis are always free. War pensioners do not pay if the prescription is for their war disability. There is concern that exemptions are arbitrary and many chronic illnesses are not included in the list. Some people on low income cannot easily afford their prescriptions and do not collect prescribed medicines when short of money, often leading to avoidable hospitalisation, which may cost the NHS more than providing free prescriptions. Administration An online tool to help patients understand the eligibility criteria for free prescriptions was launched in September 2018, and prescription exemptions were digitised to allow eligibility for exemption to be checked before they are dispensed. Pharmacies or other dispensers are reimbursed for the cost of the medicines through NHS Prescription Services, a division of the NHS Business Services Authority. Penalties A person who claims exemption without having a valid exemption certificate is liable for a penalty charge, which is five times what they should have paid, up to a maximum of £100, plus the original charge itself. If they do not prove entitlement to help with health costs, and do not pay the amount stated in the penalty charge notice, the NHS may take court action to recover the debt. The penalty charge is increased by 50 percent of the penalty charge if they do not pay within 28 days of the date the penalty charge notice is sent. 979,210 people were fined in 2016–17, double the number, 494,129, in 2015–16. Most had failed to renew their certificate, as there was no effective reminder system. The Public Accounts Committee found in 2019 that 1.7 million incorrect penalties had been overturned since 2014, almost a third of the fines issued, worth £188 million. The committee commented on the "breathtaking complacency" of the fining