OBJECTIVES:  To assess the impact of maintaining current pricing practices on total oncology spend in US and EU5 countries, and implications on average price of existing and pipeline therapies in the future METHODS:  Number and types of pipeline oncology products, list prices for existing therapies, and analyst forecasts for prices of pipeline products were gathered to calculate the anticipated total budget impact based on status quo assumptions. Multiple scenarios for “acceptable” total budget impact were then developed, to determine ranges of corresponding unit prices for individual products RESULTS:  Drug pricing practices is becoming the subject of increasing regulatory and political interest. Current forecast models often assume continued premium pricing of new oncology therapies, often beyond USD$100,000 per year in the US and €70,000 per year in the EU. However, at an aggregate level, PhRMA reports that 224 medicines and vaccines are currently in phase III testing for cancer by US companies alone. Accounting for phase III success rates, likelihood of approval, and removing trials in existing indications, large numbers of new products / indications will become available in the next 3 – 5 years. Based on current analyst epidemiology and pricing assumptions, this represents a dramatic increase in total payer spend. Assuming government / payer interventions to maintain total oncology drug spend to 1) current level adjusted for inflation 2) historical increases in total healthcare budget 3) increase in population >60, significant downward adjustments for individual unit prices would be necessary, especially in the US. CONCLUSIONS:  With increasing number of pipeline products poised to launch in the oncology space and increasing scrutiny on drug pricing across the Atlantic, a more holistic and forward looking view may be necessary for oncology pricing.