Objectives: Risk-sharing agreements (RSAs), which link coverage and reimbursement of pharmaceuticals to health outcomes, are becoming increasingly common in the United States. This study compares publicly disclosed RSAs implemented in the US since 2017 to RSAs implemented prior to 2017 to help inform stakeholders on key trends in design schemes and future strategic imperatives. Methods: Ipsos Market Access conducted a targeted online search to identify the RSAs available in the public domain as of January 2019 in the US. We also leveraged learnings from prior primary research with national and regional payers to understand current and expected future trends in RSAs from the payer perspective. The final analysis comprised 47 RSAs, including 23 implemented since 2017. Results: Prior to 2017 the majority of publicly disclosed RSAs (71%) were concentrated in cardiology (46%), endocrinology (13%) or neurology (13%). Since 2017 the RSAs being implemented have been dispersed across a much wider range of therapeutic areas (10 total, including oncology, autoimmune, respiratory). Additionally, six new health plans entered into publicly disclosed RSAs for the first time in the last ~2 years, including the first Medicaid program in Oklahoma. Conclusions: RSAs are likely to gain momentum in the US going forward, highlighting the need for stakeholders to understand the implications associated with shifting RSA market expectations and realities.