OBJECTIVES:  As payers and manufacturers turn to innovative contracting methods to increase patient access to innovative - and expensive - treatments, Italy is considered to be a prime example of a prolific user of managed entry agreements (MEAs). Italy has increasingly been using web-based MEAs to provide access to new oncology drugs in a way that does not overwhelm the healthcare budget and healthcare administration. This study will examine trends in types of web-based MEAs used in Italy over the last decade. METHODS:  Using national web-based drug monitoring lists from 2005 to 2015, monitored oncology drugs under MEAs were isolated and analyzed for an annual breakdown by type of MEA: outcomes-based, financial and outcome/financial hybrid and reason for type of MEA. These agreements were then further analyzed by indication, to determine what types of web-based MEAs are used in which indication and why. RESULTS:  Overall, web-based MEA use has grown steadily over the last decade, from 1 contract initiated in 2005 to 13 in 2015 (peaking with 20 in 2014). Of the 82 web-based MEAs initiated in the last decade, the majority most years have been outcomes-based ones, with outcomes-based MEAs making up 65% of total MEAs. In contrast, outcome/financial hybrid MEAs make up only 2% of total in the last decade. After reaching a nadir in 2012, financial MEAs have been on a rise in real and relative terms since. The MEAs span 27 oncology indications, with most indications favoring a specific type of MEA. Few indications included both major types of MEA. CONCLUSIONS:  As the pharmaceutical industry increasingly looks to value-based pricing, the prevalence of technology has allowed Italy to cut administrative costs by monitoring some drugs online via web-based platforms. Outcomes-based MEAs are favored, with web platforms allowing for easy monitoring and use of real world evidence.