OBJECTIVES: The number of technologies appraised by NICE has been increasing since 2007, with a steep increase between 2009 and 2010.  Much of this can be attributed to the influx of specialty pharmaceuticals, particularly targeted oncology therapies.  Along with this increase in the number of appraisals, the rate of ‘restricted recommendations’ and ‘non-recommendations’ has also escalated.  Various meanings and interpretations of ‘restricted’ can be applied depending on the area in which the restriction is applied (e.g. patient sub-groups, line of therapy).  This research sets out to identify recurring trends and commonalities behind products that have received a ‘restricted recommendation’ or ‘non-recommendation’ as well as standardize the term ‘restricted’ based on the impact of the appraisal on market access. METHODS: NICE appraisals between January, 2001 and December, 2013 was reviewed and analyzed through simple descriptive statistics.  The content of the appraisals were closely reviewed to identify the criteria and key elements driving each decision.  Results of this analysis were applied in standardizing the term ‘restricted’ in order to identify the implications of these restrictions on market access. RESULTS: NICE appraised 176 technologies from January 2001 - December 2013 (withdrawn appraisals and re-appraisal were not included in the analysis).  Between the time periods of 2000-2007 and 2008-2013, the average number or appraisals a year nearly doubled.  The rate of ‘restricted recommendation’ increased from 12% to 36% in the same time period and the number of ‘non-recommendations’ increased from 10% to 23%. CONCLUSIONS:  Given the high cost and targeted regimen of specialty pharmaceuticals, (e.g. biologic oncology therapies), ability to demonstrate cost-effectiveness in broad patient populations has become increasingly challenging, leading to higher rates of ‘restricted recommendations.’  Commonalities among technologies receiving ‘non-recommendations’ include use of unacceptable comparators, endpoints, and study durations.