Several British primary care trusts are rethinking their inclusion of Costco on their lists of retailers certified for reimbursement of ophthalmic services now that the international chain of superstores has lost a court appeal related to its exclusion from the city of Milton Keynes. In February, the Royal Courts of Justice in the UK ruled that Costco's £25 annual membership fee, required in order to shop there, means its ophthalmic services are not open to everyone, and therefore Milton Keynes was justified in keeping Costco off from its list. Some of the 16 primary care trusts that do include Costco on their lists are now reconsidering that inclusion. Optician reported that representatives from the PCTs of Gateshead, Birmingham and Liverpool all confirmed that their trusts are reviewing their positions, but quoted Costco as wanting open discussions with them. The ruling could also affect Costco's three optical outlets in Scotland.