OBJECTIVES To provide a comprehensive description of the current Drug Reimbursement Systems in Algeria and to compare it to two archetypes drug reimbursement systems in France and UK and to a system in a middle income country: Turkey where the HTA has been recently implemented.  METHODS We collected and reviewed relevant information to describe the health care and drug reimbursement systems in these countries; we reviewed the legal framework and procedure documents. For Algeria, in addition to the data and information collected, we conducted informal interviews supplemented by a survey among key stakeholders. RESULTS Compared to the UK, no similarities were found. This is probably due to the cultural differences and the lack of expertise in the use of cost-effectiveness approaches. Compared to the France, we didn’t find similarities, except the final decision which is taken at the Ministry level.  This is due to the administrative nature and the lack of transparency of the assessment in Algeria especially where the methods as well as the results of the assessment are not explicitly expressed. Compared to Turkey, we found some similarities in terms of process, but not in terms of methods as this country is now more familiar with the HTA approach. CONCLUSIONS Our study shows that the implementation of HTA differs according to cultural and financial factors and to expertise capacity in data collection, analysis and use in the decision making process. The use of HTA in the drug evaluation and reimbursement system in Algeria is underestimated and underdeveloped. That’s why before adopting HTA approaches in the pharmaceutical sector, the Algerian authorities should consider these factors and improve the data quality and decision process transparency. This is becoming vital as cost of drugs is increasing and the fiscal space will be more constrained in the near future.