OBJECTIVES: Pharmaceutical expenditures in Slovakia accounts for a higher share of total health expenditures than it does in any other OECD country. Although health spending is well below the OECD average when considered as a share of GDP, Slovakias pharmaceutical expenditures accounts Thirty-two percent of total health care budget. The accessibility and availability of medicines, even the most innovative products is good. METHODS: We have analysed the relevant legislation and official reimbursement decisions and commentaries, published by the MoH in 2008 that are accessible either via internet or directly per request in MoH. RESULTS: Mandatory HTA (pharmacoeconomy) is incorporated in all relevant legislation. The main drug reimbursement body - Categorisation committee of the MoH - received a special advisory body “Working group for pharmacoeconomics and outcomes research”. The working group consists of experts who evaluate all reimbursement applications for new drugs and prepare an assessment of the HTA part of the application. Recently, MoH refused reimbursement in several cases, including new indications in innovative oncology drugs. CONCLUSIONS: The focus of the MoH drug policy is on more rational spendings , especially on reference pricing and HTA. Where the reference pricing is effective from April 1, 2009, estimated savings for 2009 are up to 1 bil € ($1.34 billion), or 10% of the total drug bill. Referencing and the savings is a not repeatable issue, so the mandatory HTA is effective in practice (that means, not just legislation but also implementation) from January 1, 2009. There are first results of these new procedures, where the real impact of the HTA in the decision processes is demonstrated.