OBJECTIVES: The therapeutic reference pricing system in Slovenia was implemented for proton pump inhibitors in 2013 and for angiotensin-converting enzyme inhibitors and lipid-lowering medicines in 2014. The study aimed to assess patients’ knowledge and attitude towards the therapeutic reference pricing system. METHODS: A representative sample of 676 patients that had been prescribed at least one medicine from the three therapeutic classes was surveyed. The survey was carried out from 15^th May to 15^thJune 2014 in 40 community pharmacies with the help of the pharmacists, who filled in the first part of the questionnaire in the presence of the patients. The second part of the questionnaire was filled in by 475 patients at home and returned by prepaid mail. RESULTS: Statements describing the patient’ rights and duties within the therapeutic reference pricing (TRP) system were only known by approx. 50% of the patients or fewer in most of the cases presented to them. Of particular concern are elderly, patients with worse health condition, and low-income patients that expressed poorer knowledge about the TRP system. The patients had an inhomogeneous view of the necessity and benefits of the TRP system, including its potential for cost containment. Most of them regarded the TRP system as an unnecessary burden, which could even reduce confidence in the Slovenian health care system. Among the 50.4 % that were required to co-pay due to the TRP system, 46.7% actually co-paid for their medicine, while 3.7% of the patients rejected co-payment. On average, the co-payment was 6.92 EUR per 3 months of therapy, while the average willingness to pay expressed in the study was 10.4 EUR for three months of treatment. CONCLUSIONS: The results of the present study indicate that the implementation of the TRP system and potential upgrades in the future represent a significant challenge for patients.