OBJECTIVES: HTA agencies often review the same drugs for the same/similar indications. How often do agencies agree on their reimbursement decisions? Previous research has compared reimbursement recommendations (for the same drugs) for a limited number of agencies, but studies have rarely focused on more than 2 agencies. We collect and analyze a large number of health technology assessments from several countries to explore how often the agencies agree on their reimbursement decisions. METHODS: The data covered five agencies that make reimbursement decisions: NICE, SMC, PBAC, HAS and CADTH’s Common Drug Review.  Our analysis only included decisions for drugs that were reviewed by at least two agencies.  If a drug was reviewed multiple times by an agency for the same indication (i.e. resubmissions or updates) we used the most recent review for the analysis.  A total of 78 drugs were reviewed by at least 2 agencies, producing a total of 195 reviews. RESULTS: There was generally a high level of agreement between all pairs of agencies, ranging from 56% (PBAC; CADTH) to 91% (NICE; HAS).  It is important to note that within the sample of drugs reviewed, all agencies issued positive recommendations at very high rates – all but CADTH  issued positive recommendations for more than 80% of the drugs reviewed.  This fact alone would produce high levels of agreement, even if agencies’ recommendations were statistically independent.  Actual agreement rates observed were close to those implied by independence.  CONCLUSIONS: Agencies agree on their reimbursement decisions quite often, but at rates close to those implied by their high overall positive recommendation rates alone.  Future research will focus on identifying the determinants of agencies’ high rates of agreement.