OBJECTIVES: There are mechanisms in place to reward innovative and “life-changing” drugs. Most of these mechanisms exist in the regulatory process, but what about the reimbursement process? Are “life-changing” drugs rewarded by health technology assessment agencies with positive reimbursement decisions? METHODS: A “life-changing” was defined as providing significant improvement in benefit over existing therapies. The French ASMR score of 1 and 2 and the German additional benefit score of “major” and “considerable” identified “life-changing” drugs. Drugs that were historically known to be breakthrough therapies (e.g., Gleevec and Herceptin) were also included. Assessments from NICE, SMC, CADTH/pCODR, and PBAC were analyzed. Reimbursement decisions, clinical and economic rationales for the decision, mortality, and quality of life (QoL) data were extracted. RESULTS: CONCLUSIONS: