Patient Access Scheme(s) Project

Patient Access Scheme(s) (PAS) are one way in which pharmaceutical companies can lower the acquisition cost of a medicine to the NHS, enabling patients to gain access to high cost medicine treatments.

They are sometimes referred to as risk share schemes or market access schemes. PAS have been available via NICE since 2002, and also more recently via the CDF. Although PAS unequivocally aim to improve access to new medicines for NHS patients, it is essential that the costs of operating them and the financial benefits actually realised locally are assessed as carefully as the clinical benefits of the medicines themselves to ensure that they offer the NHS genuine value for money. If PAS are not implemented the NHS may incur unnecessary costs. Implementation of NICE-approved PAS also ensures local compliance with NICE technology appraisal guidance.

PAS operate via two main mechanisms:

  • "Price discount schemes" – the pharmaceutical company passes on a straight forward discount of X% on the price of the drug. This will be the price invoiced to the organisation and no new internal process/mechanisms require implementation.
  • "Manual managed discount schemes" – an internal process/mechanism has to be implemented in order to allow the potential cost avoidance to be realised. This may be resource intensive and involve multiple departments within the organisation.

The PAS Project

LPP is continuing the PAS project initiated in 2013, which has now been expanded to encompass all non-cancer and cancer PAS, both NICE-approved and those in the CDF.

One of the main aims of the project is to ascertain if the PAS are being successfully implemented and if not, to assist with implementation. To do this, work has been undertaken to identify, map and track use of PAS in London, and to identify any barriers to implementation. Cost avoidance derived from the use of PAS is also calculated for each drug and organisation. It is important to note that since evidence so far shows that in London compliance with PAS is very high, provider financial plans will reflect PAS prices. The cost avoidance quantified by this monitoring exercise does not therefore represent new, cash-releasing savings opportunities for providers.

The initial data gathering exercises, for the manual or non-discount schemes, over the last two years enabled us to identify which schemes were being taken up by each trust across London.
With the help of each individual organisation, we now make this a routine exercise for all PAS so that we can continually assess the cost avoidance derived and thus the benefit of the schemes for London NHS trusts.

The information received from previous data collection exercises indicates that there is a very high level of uptake, with a total cost avoidance for both discount and manual schemes of approximately £44 million in 2013/2014.

Reports to facilitate identification of apparent instances of variance from PAS discount pricing are sent to trusts on a quarterly basis, commencing March 2015.

Further information

A list of NICE-approved PAS is available on the NICE website:

To sign up for the NICE-maintained Operational PAS Update e-mail list, send an e-mail to with 'Operational PAS Update' in the subject line.

For more information on high cost drugs uptake, please refer to the Innovation Scorecard on the Health and Social Care Information Centre website at and the Innovation Scorecard section on NHS England's website at

Northern, Eastern and Western Devon Clinical Commissioning Group and South Devon and Torbay Clinical Commissioning Group have produced a list of currently available PAS, which is available at

Data collection for manual managed discount schemes

To improve data collection for the manual managed discount schemes, we have designed an online tool via which organisations can enter their data.

printable copy of the survey can be accessed via the Supporting Information box on the right of this page.


For enquiries regarding availability of previous PAS reports, or for any other information please contact the PAS project team. For cancer PAS and non-cancer PAS contact Pauline McCalla on