OBJECTIVES: Pharmaceutical drug costs represent a large portion of government health care spending. A national standard to regulate the process of public financial reimbursement for drugs does not exist in Canada and variations in practices are evident across the country. The purpose of this study was to provide a comprehensive overview of how drug-funding decisions are made in Ontario. METHODS: Access to Ontario’s Committee to Evaluate Drugs (CED) meeting minutes (July 2009-July 2010) was granted. A data abstraction form was created based on the framework established by Johnson et al. (2009). For each criterion, importance to the final decision, strength of evidence and quality of evidence were recorded. Two reviewers independently extracted the information and consensus was achieved. RESULTS: Forty-four submissions were included. Five main observations: 1) the CED considered certain criteria more frequently than others (e.g., clinical benefit was considered for all decisions, while societal values were discussed less frequently); 2) the relative impact of each criterion on the CED’s recommendation varied (e.g., overall clinical benefit, efficacy, value for money, and need had the largest influence); 3) the CED was more likely to discuss the strength of evidence when its recommendation did not support public funding (e.g., the strength of cost evidence was discussed 3 times more often for those drugs not recommended for funding); 4) the frequency with which the CED considered criteria varied according to whether or not the CED believed there was an established need; and 5) the majority of the comments made by the CED about the strength of evidence indicated that the quality of the data was low. CONCLUSIONS: This review identified trends in the influence of different criteria involved in the CED’s drug assessment process. These results may promote the development and application of a comprehensive, consistent, and transparent framework for reimbursement decision-making.