OBJECTIVES: Comparison of regulatory rules and procedures for pricing and reimbursement of pharmaceuticals between Bulgaria and the Czech Republic (CR). METHODS: Medicine laws, health insurance laws, corresponding regulations stating the pricing and reimbursement procedures were reviewed. Special emphasis was devoted to the requirements for pharmacoeconomic evidences in the procedures. RESULTS: Both countries apply the reference pricing system for prescription medicines and the CR is among the 8 reference countries for Bulgaria, while the opposite is not the case. In Bulgaria the lowest reference price for ex-factory price setting is used, while the CR employs the average among the three lowest prices. There is also a regressive margin scale in both countries applied. In Bulgaria margins are stated for wholesalers and retailers separately, while in the CR they are negotiated between wholesalers and retailers. In both countries health insurance is obligatory. In the CR there are 11 insurance companies and in Bulgaria - only one fund. In Bulgaria reimbursement is in the form of positive drugs lists. For reimbursement of pharmaceuticals in the CR a complex external and internal referencing is employed and evaluation of innovativeness is necessary. There are 111 internal therapeutic groups defined at the 4th ATC level (e.g. statins). The reimbursement base is set as the cheapest price of medicine in the group in all 27 EU countries. There is a bonus of maximum 30% if a medicine shows superiority. In Bulgaria the reimbursement level is defined as the cheapest price per DDD for every INN. Both countries require pharmacoeconomic evidences, but there are guidelines in the CR, while Bulgaria applies only criteria for evaluation. CONCLUSIONS: We consider the Czech system more flexible and providing freedom for the manufacturers and distributors due to its negotiating practice and therapeutic level of reimbursement, but the process is more prolonged.