OBJECTIVES Due to rising healthcare costs, stricter governmental cost containment measures like international price comparison and external reference pricing, the European pharmaceutical markets will lead to future challenges in pricing. Despite of these prices of pharmaceuticals vary across European countries. Thus, the aim of the analysis was to draw a comprehensive picture of the pharmaceutical price levels and consumption (expenditure per capita) of pharmaceuticals in Europe. METHODS The study analyzed drug prices of the outpatient setting (Rx and OTC) of all countries of the European Union except Denmark plus Switzerland. Based on ex-factory prices per Standard Unit SU (tablet, vial etc.), price indices were calculated. Study results showed international pharmaceutical price levels (in Euro and purchasing power parities) and expenditure per capita. Observation period was the year 2012. Data were collected via international literature review and based on IMS Health data on file. RESULTS The international comparison of prices indices based on SU prices showed (European average price = 100), France (138) and UK (126) had the highest price indices and in contrast to Netherlands (69) and Romania (69) were at the lower end. In the international country sample, the Netherlands had the highest health expenditure (11.91% of GDP) in 2011, closely following by France with 11.33% of GDP. Subsequently, Switzerland occupied a leading position based on the determined price index per capita (187) per ex-factory price, followed by Sweden (167). The rear was Romania (45). CONCLUSIONS In case of converting drug prices with purchasing power parities differences between drug prices and affordability in different countries were found. Low income countries reported less affordability of drugs, leaving room for potential problems with drug access, and consequently, a negative impact on health.