OBJECTIVES: We surveyed pharmaceutical prices in 18 countries (mix of developed and emerging countries). The goal of the survey was to analyze and compare drug prices in an attempt to determine the countries where drug pricing procedures are more favorable or more stringent, as well as the countries where price cuts are common and where price increases can still be expected. METHODS: The methodology was based on estimated ex-manufacturer pricing data from PharmOnLine International, looking at current and historical drug prices in 18 countries. For each country, all prescription drugs by average manufacturer prices were looked at, as well as by therapeutic area. Several case studies were also analyzed. RESULTS: With countries having their own legislation and standards when it comes to drug pricing, significant price differentials are seen between countries. By far, conditions are still most favorable in the US. Legislation is more restrictive in other markets, notably in the European Union. Our data finds that the ongoing pricing reform in Germany has already had a significant impact on drug prices, which are dropping. Conditions are more attractive for innovative drugs in certain emerging countries - including Brazil or Russia - where pharmaceutical companies are increasingly investing as demonstrated with the large number of innovative drugs marketed in those countries. Additionally, a significant number of case studies demonstrate that innovative drugs are highly priced and that price increases can still be expected in those countries. CONCLUSIONS: With stringent pricing legislations in developed countries, opportunities are now seen in emerging countries where pharmaceutical companies increasingly invest. In these markets, the challenge is seen at the reimbursement and volume levels. Nevertheless, with governments enhancing their healthcare systems, the data points to the conclusion that the basket of drugs funded will increase in the near future.