OBJECTIVES: In December 2011, a threshold value of costs/QALY was introduced to Slovak legislation. The aim of this work is to assess its impact on inclusion of oncology drugs to the reimbursement system and their availability in clinical practice. METHODS: We evaluated the inclusion of oncology drugs to the reimbursement system based on data from the website of the Ministry of Health SR. We analysed the consumption of drugs based on the National Health Information Centre database. We acquired information about registered oncology drugs on the EMA website. We determined the level of availability of oncology drugs in clinical practice via a qualitative survey among oncologists. RESULTS: The success rate of including new oncology drugs in Slovakia was high in 2000-2011. From the 62 oncology drugs registered in this period by the EMA, 48 were included to the Reimbursement List. Innovative oncology drugs were included relatively quickly to reimbursements, causing a significant growth in costs. Expenses for oncology in 2003-2011 increased by 718% (from € 15.4 million to € 125.7 million). In December 2011, a cost/QALY threshold was introduced to legislation, creating a barrier to the inclusion of oncology drugs to the Reimbursement list. Following adoption of this legislation, of the 12 drugs registered by the EMA, only 3 oncology drugs were included to the List during 2012-2014. Uncategorized drugs are available only for a limited number of patients by way of individual exceptions, or by participation in clinical trials. CONCLUSIONS: In Slovakia, the willingness to pay for an additional unit of health was anchored in legislation, which greatly limited the availability of innovative oncological treatment. The health system in Slovakia needs to introduce efficient and transparent mechanisms that enable the treatment of oncology patients in line with the latest medical findings, while keeping expenses for treatment within economic possibilities.