OBJECTIVES: With the increasing financial constraints facing healthcare systems, innovative pricing and reimbursement schemes between payers and pharmaceutical manufacturers are frequently discussed as a means of addressing the uncertainty and financial concerns faced by both parties. The objectives of this study were to review innovative pharmaceutical pricing and reimbursement schemes across global markets and to quantify their occurrence over time. METHODS:   The literature search included two components: a search of published literature on pharmaceutical pricing and reimbursement schemes performed in PubMed/MEDLINE and a search of “grey” or unpublished literature conducted via the Internet. Search terms used included “patient access schemes” and “risk-share agreements”. Identified schemes were classified by country, payer, therapeutic area, indication, drug, year, type (financial or outcomes-based) and structure (e.g., coverage with evidence development). Where applicable, multiple sources were used to obtain a full picture of a specific scheme. RESULTS: A total of 225 schemes were identified between 1994 through 2011. 38% of the schemes were from the United Kingdom, followed by Italy (16%) and the United States (11%). 48% of the schemes were classified as outcomes-based and 49% as financial-based (49%). The number of schemes identified per year remained under 10 until 2007, when 27 were identified. The number of schemes peaked in 2009 with 33, decreasing to 17 in 2010 and 13 in 2011.  Schemes for oncology products comprised 50% of all identified schemes, followed by neurology and musculoskeletal products (10% each).   Within outcomes-based schemes, 46.2% were classified as conditional coverage and 40.5% as performance-based reimbursement. CONCLUSIONS: Pricing and reimbursement schemes such as risk-share agreements appear to be most frequently used in oncology. The UK had the most schemes per country, likely as a result of the inclusion of patient access schemes in the NICE process.  Understanding the landscape of existing schemes can potentially aid in developing new schemes.