OBJECTIVES: Since their introduction, access arrangements such as patient access schemes (PAS) have become increasingly common in the UK. The objective of this analysis is to describe trends in uptake of commercial arrangements over time and to compare arrangements that have been implemented for National Institute for Health and Care Excellence (NICE) recommended medicines.

METHODS: A complete list of appraisals undertaken by NICE up to 30 June 2020 was extracted and analysed against published details of commercial arrangements. Products receiving negative recommendations were excluded from analysis. Decisions from multiple technology appraisals assessing >1 product or indication were counted as discrete outcomes. The proportion of appraisals utilising a commercial arrangement was calculated each year using the number of positive recommendations as the denominator.

RESULTS: A total of 956 decisions were reviewed, of which 739 (77%) were positive. The proportion of approved products with any commercial arrangement generally increased from 2007 to 2020, with a peak of 91% (50 of 55 recommended products) in 2018. Over the last 5 years, approximately two thirds of positive recommendations were supported by a commercial arrangement of some form. The most common type of arrangement was the simple PAS, accounting for an average of 61% of all commercial arrangements from 2007 onwards. We identified a shift away from use of the complex PAS, towards more frequent use of commercial access agreements (CAA, with or without associated PAS) over the last 5 years (from 14% to 36%).

CONCLUSIONS: There has been an increasing trend towards confidential agreements (such as simple PAS and CAA) since 2007. In part this is likely to reflect the challenges of achieving UK access in a wider context of global markets and price referencing. With the increasing prevalence of high cost therapies, this is a trend that is set to continue.