Patient access scheme

Patient access schemes (PASs) are pricing agreements proposed by pharmaceutical companies to enable patients to gain access to drugs or other treatments that may not be considered to be cost effective under normal circumstances. In effect, they are typically forms of simple price discounting that enable companies to retain control of (undiscounted) list prices across countries and facilitate discount renegotiations should the need arise. A simple PAS is confidential and provides a fixed or percentage discount off the normal list price, while a complex PAS uses a detailed reimbursement proposal and is non-confidential to aid transparency. More complex schemes may include outcomes-based dose caps, rebates and upfront free stock. In England, after proposed schemes are approved by NHS England, they are reviewed and evaluated by NICE. NICE provides initial guidance, assesses them for feasibility, and then advises NHS England to determine their suitability. Principles and terms for these schemes were set out in the 2024 Voluntary Scheme for Branded Medicines Pricing and Access and the NHS Commercial Framework for New Medicines. Similar arrangements for Scotland are co-ordinated by the Scottish Medicines Consortium. If a medicine subject to a PAS becomes a comparator in a technology appraisal for a new intervention, it is the discounted (post-PAS) price that will need to be considered in that appraisal.