OBJECTIVES: To provide an overview of past and current models and practices in innovative contracting in Germany, the UK, Sweden, Italy and France. Another aim was to uncover the experiences of different stakeholders with innovative contracting in Germany and the UK. METHODS: A comprehensive literature search on innovative contracting from 2008 onwards was performed. Information on the country involved, drug type, characteristic of the therapeutic area, timeframe, terms of the agreement and stakeholders involved was extracted. Interviews with 22 stakeholders from Germany (n=14) and the UK (n=8) were conducted.  Stakeholders included pharmaceutical company staff, payers, medical practitioners, governmental bodies and academics. RESULTS: The countries showing the highest activity in the use of innovative contracting were the UK (23 from 60 contracts), followed by Sweden (15/60) and Italy (10/60). Most schemes were applied to oncology drugs (29/60). The most frequently mentioned innovative contract model in the literature was the Coverage with Evidence Development (CED) scheme (23/60). From the interviews, it was observed that most stakeholders applied these schemes mainly to arrange broad market access, and were successful in their implementation (32%). Where stakeholders avoided innovative contracting schemes, this was due to their complexity, high administrative burden, and uncertainty of its benefits, particularly for payers.  The high administrative burden was regarded as the greatest pitfall of innovative contracting schemes, being mentioned by 45% of the stakeholders. For the future, they prefer the use of simple rebate schemes. CONCLUSIONS: Innovative contracting provides a valuable tool for new innovative pharmaceuticals to gain market access whilst keeping the impact on payers’ budgets under control. These schemes have not yet gained wide-spread acceptance, and stakeholders in the UK and in Germany are suspicious as to their benefit and their future relevance. Systematic research is needed to allow for the evaluation of these schemes.