OBJECTIVES: Patient access schemes for novel medicines are increasingly implemented in the UK, being based on linking payment to result (outcome-based) or capping cost per patient (finance-based). However, little is known about what schemes are actually being run, how useful they are perceived to be and what are the challenges faced. We investigated these questions. METHODS: During this qualitative survey, we held in depth, open-ended discussions with senior NHS/NICE representatives (n=11), academics and healthcare consultants (n=6), and senior pharmaceutical industry representatives (n=7). The focus was on patient access schemes for new drugs implemented in the UK during 2000-mid 2009. RESULTS: Of the 13 schemes identified, most are in oncology (n=9), and finance-based (n=8) rather than outcome-based; seven are included in positive NICE appraisals. Awareness and implementation of these schemes are highly variable, albeit less for NICE-endorsed ones. NHS respondents acknowledged the theoretical utility of the schemes in reducing uncertainty about value for money and (for local stakeholders) shifting some of budget impact risk towards the industry. But they saw important challenges:  potentially cumbersome administrative burden, lack of capabilities to assess real implementation costs, and high uncertainty about whether relevant NHS stakeholders actually obtain the financial payback. For industry stakeholders, the schemes were essentially a means to obtain NICE approval following initial rejection, while preserving a high UK price (crucial in the context for international price referencing).  A lesser consideration was the potential for competitive advantage through, for example, positive perceptions about the product and company. CONCLUSIONS: NHS and industry stakeholders generally see patient access schemes as beneficial, at least in principle. This approach will likely continue for high cost drugs that would otherwise have a cost/QALY marginally over the accepted threshold. Adoption of more schemes will depend upon the future capability of the NHS to accurately monitor their financial benefits and implementation costs.