Assessment in higher education (HE) is often focused on concluding modules with one or more tests that students need to pass. As a result, both students and teachers are primarily concerned with the summative function of assessment: information from tests is used to make pass/fail decisions about students. In recent years, increasing attention has been paid to the formative function of assessment and focus has shifted towards how assessment can stimulate learning. However, this also leads to a search for balance between both functions of assessment. Programmatic assessment (PA) is an assessment concept in which their intertwining is embraced to strike a new balance. A growing number of higher education programmes has implemented PA. Although there is consensus about the theoretical principles that form the basis for the design of PA, programmes make various specific design choices based on these principles, fitting with their own context. This paper provides insight into the design choices that programmes make when implementing PA and into the considerations that play a role in making these design choices. Such an overview is important for research purposes because it creates a framework for investigating the effects of different design choices within PA.