OBJECTIVES: Risk-sharing schemes have become increasingly frequent in health technology assessment internationally. The degree of alignment between these schemes for a specific treatment annd indication across different regions, however, is not entirely clear. In the United Kingdom, patient access schemes (PAS) are accepted within submissions to the National Institute for Health and Clinical Excellence (NICE) in England, and the Scottish Medicines Consortium (SMC) in Scotland. We compared guidance published by NICE and the SMC to identify similarities and differences between PAS for the same treatment and indication in these regions. METHODS: All NICE technology appraisals published in 2010 and 2011 were reviewed. Treatment appraisals with PAS were identified and the corresponding submissions to the SMC were analysed for the presence and nature of a PAS. PAS were defined as the manufacturer providing a pre-defined reduction in the overall cost of treatment through risk-sharing or rebate schemes. RESULTS: In 2010 and 2011, 15 technology appraisals published by NICE included PAS, 13 of which had equivalent submissions to the SMC. Of these 13 submissions, 7 were recommended by both NICE and the SMC, 1 was recommended only by NICE, and 5 were rejected by both. For treatments recommended by both NICE and the SMC, only 3 submissions included a comparable PAS, which consisted of a discounted price in all cases. Of the 4 remaining recommended appraisals, only 2 had a PAS included in the SMC submission, which was a simple discount in both cases. In the NICE appraisals, however, these submissions included more complicated PAS, such as treatment cycle rebates and price matching schemes. CONCLUSIONS: There is some alignment between PAS included in submissions to NICE and the SMC; however, where there are inconsistencies the SMC appear to accept more simple discounting schemes.