OBJECTIVES: To assess and compare patients’ access to biologic anti-RA drugs in selected CEE countries (Bulgaria, Croatia, Czech Republic, Estonia, Hungary, Poland, Romania, Russia, Serbia, Slovakia, Slovenia) and to analyse the determinants of differences between countries. METHODS: This is a multi-country survey study, based on a combination of desk research and direct contact with national RA stakeholders. Data was collected using a pre-defined questionnaire. Affordability was measured using affordability index, calculated comparing the health care expenditures index to the price index, using Poland as an index of 1. A higher index indicates more limited affordability. RESULTS: The percentage of patients on biologic treatment in 2009 was highest in Hungary (5%), followed by Slovenia (4.5%), Slovakia (3.5%), Czech (2.92%), Romania (2.19%), Estonia (1.8%), Croatia (1.4%) and Serbia (1.3%), lowest in Poland (1%). Infliximab, etanercept, adalimumab and rituximab are included in the reimbursement system in all countries (latest in Bulgaria), abatacept and tocilizumab - only in Slovakia. In Slovenia public payer covered 75% of the price, 25% was covered by supplementary health insurance; in Bulgaria public payer covered 50% of etanercept and adalimumab costs, and 75% of rituximab cost. In other countries biological drugs were reimbursed in 100%. Affordability index for biologic drugs was lowest in Slovenia (0.4), followed by Hungary (0.6), Czech Rep. (0.7), Estonia (0.9), while countries with health care expenditures below 500 USD/capita (Bulgaria, Romania and Serbia) had the highest indexes (1.4-1.9). In each country national guidelines defined which patients were eligible for biologic tretament, and some also defined the sequence in which drugs should be used.  DAS28 of over 5.1. and failure of 2 or more disease-modifying anti-RA drugs, including methotrexate, are commonly used criteria.   CONCLUSIONS: The most important factors of limited access to biologic anti-RA treatment CEE region are macroeconomic conditions and restrictive treatment guidelines.