OBJECTIVES: In the face of universal budget restrictions, pricing of pharmaceuticals remains a divisive subject. The US government is increasing its involvement in healthcare provision and insurers will have more budget pressures due to increased coverage.  In the UK, the government has proposed a value based pricing approach which will potentially increase the availability of new drugs. The objective of this research is to better understand the future outlook for patient access schemes (PAS) in achieving affordable budget impact whilst not restricting patient access. METHODS: 40 telephone interviews were undertaken with payers in the UK, US and Taiwan representing government agencies, HTA groups and insurers. We asked interviewees about their perceptions of PAS policies to provide required value evidence, improve affordability, strategies that could be used by manufacturers and likely future changes. RESULTS: Results demonstrated that manufacturers will aim for a particular price or price threshold; if this is not accepted by payers, outcome-based schemes or other flexible pricing arrangements would be proposed for manufacturers to establish that their product is cost-effective and to achieve revenue targets. UK payers will find it difficult to determine the level of weighting applied to different unmet needs or to assign various rewards on value. Respondents stated that PAS could be a method used to determine the level of value through monitoring outcomes, but administrative burdens need to be considered. In the US, market evolution will accelerate the uptake of patient access schemes. Taiwan is likely to introduce PAS approaches as a means to reduce expenditure on high cost drugs. CONCLUSIONS: The current budget constraints in the different countries may lead to an increased interest in implementing PAS, which in turn may change the way health systems look at value for patients.