OBJECTIVES When assessing trends in NICE HTA decisions it would be useful to ascertain their implications on access for groups of technologies.  A specific issue is to understand the degree of access associated with ‘optimised’ decisions, where usage has been restricted to a subgroup of patients relative to the scope of the appraisal. Using a previously developed method, we calculate the degree of recommended access for medicines and assess trends between 2008 and 2013 by therapeutic area and over time. METHODS: In a previously published paper we developed a measure, M, to assess access associated with NICE technology optimised appraisal decisions.  This was defined as M=(p/P)X100, where M is a measure of the level of patient access (0 equals no access, 100 full access), P is the set of patients considered in the guidance as potential candidates for treatment (given the scope of appraisal and license), and p is the number of patients for whom NICE did recommend. Applying measure M to NICE HTA decisions for medicines between January 2008 and December 2013 we assess trends by therapeutic area and over time.  In this paper, to understand trends, we extend the analysis to include recommended and not recommended decisions. We assume a recommended decision scores 100 using measure M, a not recommended decision 0, and optimised decisions, where not possible to determine M, a score of 50. RESULTS: For 201 decisions between 2008 and 2013, on average, M was equal to 52, ranging from 37 in 2008 to 57 in 2011.  At therapy level, M scored between 38 for cancer medicines to 100 for Hepatitis C treatments.   CONCLUSIONS: The results for this period suggest around half of patients have been recommended by NICE to receive treatment, relative to scope of appraisal and licenseThese considerations address access not implementation issues.