OBJECTIVES: Tiered pricing, also referred to as differential pricing or equitable pricing, involves adjusting drug prices to the purchasing power of consumers in different geographical or socio-economic segments. Traditionally, tiered pricing strategies have aimed to improve access to medicines in the developing world. There has been increasing interest from manufacturers and payers in employing such strategies for oncology agents, but improved patient access and commercial success has been variable. This research aims to understand the challenges and opportunities associated with implementing tiered pricing for oncology agents and the factors that may contribute to a successful strategy. METHODS: Systematically analyse a set of case studies in order to clearly identify current practice and trends in tiered pricing strategies for cancer drugs in key emerging markets. Evaluate various strategies based on publically available information and identify drivers for improved patient access and commercial success. RESULTS: Emerging markets represent a complex environment and a number of challenges such as physical and informational arbitrage impact a differential pricing strategy. Strategies driven by short-term profitability objectives have usually failed and those that have not addressed the inefficient distribution channels in emerging markets have also struggled to gain traction. Additionally, a poor knowledge of demand elasticity has often limited impact. CONCLUSIONS: Tiered pricing strategies represent a powerful tool for improving patient access to cancer drugs in emerging markets. Every tiered pricing strategy needs to be tailored to each product and market/ segment. A clear understanding of the objectives driving the strategy, the potential pricing tools applicable in a market, the distribution channels and methods to mitigate risk are key to improving patient access and supporting commercial success.