OBJECTIVES: To assess the implications of Croatia’s accession to the European Union for the pricing and reimbursement landscape both in Croatia and other EU member states, focusing on international reference pricing. METHODS: Changes to Croatia’s laws governing drug pricing and reimbursement were examined in detail, in relation to their likely effects on drug prices in Croatia and in other EU member states through international reference pricing. The IHS International Reference Pricing Matrix was used to determine impact of Croatian prices on other markets likely to include Croatia in their reference pricing basket. Interviews were conducted with representatives of the pharmaceutical industry in Croatia, and regulators in Croatia and other EU member states, to gauge their views. RESULTS: The existence of comparatively low prices of medicines in Croatia is likely to result in some downward pressure on pricing in countries which include all EU countries in the IRP basket of countries. However, this impact is not likely to be felt immediately, and only for the few therapeutic areas where Croatia’s prices are among the lowest in Europe. Changes to Croatia’s international reference pricing basket are unlikely to result in any great changes, although in certain areas, price reductions can be expected. CONCLUSIONS: Some downward pressure on prices in other EU markets is likely as Croatia becomes a reference market for IRP, although this is likely to be limited in scope in the short term, with only particular products and therapeutic groups affected. Over the longer term, as more markets add Croatia to their reference-pricing baskets, this pressure is likely to intensify.