The government's NHS prescriptions policy has been dismissed as a "dog's dinner" by an influential think tank.
The current charge for NHS prescriptions is £6.30
The Social Market Foundation said the current rules on who pays for medicines and who does not are unfair and illogical.
It has called for sweeping changes to the current system.
These include scrapping charges for some groups of patients and forcing others, including the elderly, to pay for prescription medicines for the first time.
The proposals follow a review by the think tank's health commission.
Linked to income
It found that some of the sickest and poorest patients are often forced to pay for prescription drugs while others who are better off get them free.
In a report published on Monday, it proposes that prescription charges should, in future, be related to the ability to pay.
The present system of NHS charges is a dog's dinner lacking any basis in fairness or logic
Social Market Foundation
It has called for charges for teenagers over 16 but not in full education and people on low incomes to be scrapped.
It also wants the national charge for prescriptions - currently £6.30 - to be abolished.
It suggests there is a strong case for linking charges to patients' income. However, it acknowledges that the cost of introducing such a scheme "rules this out for the immediate future".
Instead, it proposes that charges are linked to the type of drugs patients are prescribed.
For instance, it suggests that life-saving medicines and drugs for chronic illnesses should be cheap or free while those for less serious conditions or lifestyle medicines should carry a higher charge.
But the report maintains that free prescriptions should generally be related to the ability to pay.
In line with this, it suggests scrapping the automatic exemptions for pregnant women, new mothers or older people.
However we set out the system of allowances and exemptions, it is not easy to create one which is perfect for everyone
Department of Health spokeswoman
The report also calls for changes to way the NHS provides dental and optical services.
It suggests everyone should be entitled to free regular dental check-ups and preventive or essential treatment on the NHS. But it suggests that all other treatments should be provided privately.
In addition, it backs free eye tests for everyone and calls for an investigation into the cost of spectacles in the private sector.
It suggests that the Office of Fair Trading should examine whether there are "perverse incentives" for opticians to artificially inflate the cost of glasses.
Lord Lipsey, who is a Labour peer and chairman of the Social Market Foundation, acknowledged that the proposals are radical.
But he said: "The present system of NHS charges is a dog's dinner lacking any basis in fairness or logic and stuffed with anomalies and inconsistencies."
He added: "The settlement we propose will clearly mean that some people will have to pay for things that are currently free.
"But it will also mean that the sickest and the poorest get help that is currently denied to them."
The Department of Health said it regularly reviewed its prescription policy.
A spokeswoman said: "The general principle is that free prescriptions and optical and dental checks are related to the ability to pay.
"We keep these areas under review with that principle in mind, but however we set out the system of allowances and exemptions, it is not easy to create one which is perfect for everyone."