OBJECTIVES: Despite the premise of universal access supported by its Constitution, the Brazilian healthcare system is subject to similar financing issues as in other jurisdictions worldwide.  A misunderstanding between Constitutional rights and healthcare budget restrictions leads to the controversial model of procedural justice.  The objective was to describe the characteristics of the current decision-making scenario in Brazil using Health Technology Assessment (HTA), its main actors, consequences and future opportunities. METHODS: A review of HTA regulation in Brazil and the published literature on the topic was conducted.  The Brazilian HTA model was discussed and strengths and weaknesses highlighted. RESULTS: Over the years, drug expenditures and healthcare demand have grown exponentially in Brazil.  In 2006, the Brazilian Ministry of Health (MoH) created a HTA process (Regulation #152).  The main objective was to align the dynamics of health technology decisions with population social needs, epidemiological profile, and healthcare system financing characteristics.  The principal components are a clinical review and economic analysis of technologies under evaluation.  Multiple government players are involved, but no reference to external involvement.  Health technology decisions take into consideration: a) the relevance/impact of the technology within the system, and b) the safety, effectiveness, and cost-effectiveness of the appraised technologies.  No reference was found to what is considered cost-effective/efficient for the system.  Proposed HTA regulation changes are underway and include: rapid response, societal engagement (i.e., public consultation of MoH decisions), and changes in decision determinants (i.e., economic impact to be least important). CONCLUSIONS: Currently, Brazil holds an informed health technology decision-making process.  However, clear/objective parameters for aiding decisions have not been described or yet proposed.  Uncertainty still remains with regards to efficient health technology decisions.  Current initiatives to improve HTA process are controversial.  In the future, HTA could serve as a mediator between constitutional obligations and current budgetary restrictions in the country.