OBJECTIVES: With payors increasingly looking at ways of cutting pharmaceutical reimbursement costs, pharmaceutical companies need to consider creative solutions to market access for new compounds. The objective of this research was to examine the most recent global trends for 2010 and 2011 in pharmaceutical risk-sharing agreements, which are now a critical part of market access strategies in many countries. METHODS: Secondary research was conducted examining reimbursement decisions around the world, with a special focus on Australia, Belgium, Canada, China, France, Germany, Hungary, Italy, Netherlands, New Zealand, Poland, Spain, United Kingdom and United States. This was supplemented by primary research with payors, government agencies and HTA organisations through interviews in native languages to understand the role which risk-sharing agreements have – or have not – played in their respective markets. RESULTS: Forty-five new risk-sharing agreements were found under the period of review (January 2010-May 2011), nearly double the total for 2009. Of the new agreements, the majority were finance-based agreements, though there were six new examples of performance-based agreements. 40% of the new agreements were concluded with the UK’s NICE, whilst Australia and Italy remain other important markets in this area. However, a significant number of newer countries are beginning to see these agreements, including Belgium, Hungary, Poland and New Zealand, and interest is widening in emerging markets. Around half of the agreements were in the oncology area, but there are signs that risk-sharing is becoming increasingly prominent in other therapeutic areas, including blood disease, mental health, pain treatment, immunology, ophthalmology and cardiovascular care. CONCLUSIONS: Risk-sharing agreements are a reality for pharmaceutical companies in many key markets, and need at least to be considered as an alternative market access strategy in certain therapeutic areas.