BACKGROUND: In an increasingly resource-constrained environment, a variety of innovative contracting arrangements exist, representing an alternative to conventional pricing and reimbursement agreements between payer and manufacturer. There are various tools and resources that may influence funding with which payers and prescribers would welcome support from manufacturers. OBJECTIVES: To gain an overview of contractual agreements currently used within the pharmaceutical sector and to uncover how innovative contracting has, and continues to, evolve. METHODS: Secondary research was conducted to identify examples of innovative contracting, highlighting elements that work and associated hurdles, in order to understand issues relating to transparency and implementation. RESULTS: 16 markets worldwide embrace innovative schemes with a further 5 markets beginning to show uptake. In the past, agreements were predominantly performance-based. However, companies are increasingly moving towards financial schemes such as product bundling, confidential discounts and fixed price treatments. The most common elements of risk-sharing agreements are price volume agreements (39%), requirement for data collection (29.5%), and access limited only to eligible patients (13.1%). Innovative contracts are predominantly used for drugs that relate to high cost or high performance with oncology being the therapeutic area that dominates these agreements. CONCLUSIONS: Innovative contracting schemes can aid manufacturers with market access, help to maintain price and increase usage. However, the current design of many agreements is suboptimal, and there are hurdles which need to be overcome. It is important that there is a balance between risk and incentive for all stakeholders, and this balance between the benefits and cost implications must be carefully considered.