OBJECTIVES: In recent years there has been an increasing strain on healthcare budgets. As a result, policymakers have adapted the framework for evaluating new medicines so manufacturers need to demonstrate additional benefit and value for money to achieve reimbursement. One of the key policy tools available are managed entry agreements. In the UK these are assessed as patient access schemes (PAS) which have been successfully used to obtain cost effectiveness since 2007. PAS are negotiated on a case by case basis and range from simple discounts to more complex arrangements. The objective of this study was to assess the changing dynamics of PAS within the UK against a background of changing structures of healthcare delivery and a greater drive to save costs. METHODS: A search of all approved Health Technology Assessments (HTAs) incorporating a PAS for either NICE or the SMC between October 2007 and June 2015 was undertaken. In addition, numerous sources including structured interviews were analysed to identify the key structure and changing dynamics of PAS. RESULTS: