OBJECTIVES: In the UK, Patient Access Schemes (PAS) have become more common in submissions to the National Institute for Health and Clinical Excellence (NICE). The increase in PAS is a result of the essential role such schemes play in enhancing the availability of high-cost treatments to payers. In published appraisals, minimal emphasis has been placed upon the administrative burden of PAS, which is typically described as ‘acceptable’.  The aim of this study was to assess the impact of administering PAS in the UK, using both primary research and existing literature to identify key administrative challenges. METHODS: A literature search was conducted using PubMed and Google Scholar.  Freedom of information requests were sent to NICE for data on PAS administration. A pilot questionnaire was distributed to all 19 contacts listed on the directory of NHS Chief Pharmacists in Wales, to assess the real-life burden of PAS administration. RESULTS: Limited literature is available on the administration of PAS. However, the literature search uncovered evidence that the administrative impact of PAS is being recognised. The creation of the Patient Access Scheme Liaison Unit (PASLU) in October 2009 and the publication of the Pharmaceutical Price Regulation Scheme (PPRS) are two such developments, both of which are steps towards a system that more accurately reflects the needs of NHS administrators. The return-rate for the questionnaire was low; however, responders showed dissatisfaction with multiple aspects of PAS management. Responders emphasised the need to address NHS requirements (both financial and temporal) in order to facilitate accurate PAS administration. CONCLUSIONS: Encouraging steps have been taken to recognise the burden of PAS on the NHS; however, further research is required to assess whether these recent developments are meaningful in every-day practice. Additional support for appropriate PAS implementation must also be provided if these important schemes are to continue effectively.