OBJECTIVES: An increasing number of European countries is implementing Managed Entry Agreements (MEAs) in their health care systems thereby trying to keep the budget sustainable. Although most countries apply simple price-volume contracts, there is a growing need for more complex performance-based or payment-by-results risk sharing agreements. The aim of this research is to determine what types of MEA (according to article 83, 2° of the RD of 21.12.2001) were concluded since the introduction of risk-sharing schemes in Belgium in 2010 and to define the reasons of success and failure of specific budgetary compensation types. METHODS: All MEAs demanded between April 2010 and September 2016 were clustered into type of risk-sharing agreement (according to article 83, 2° of the RD of 21.12.2001). RESULTS: The majority of MEAs include the requirement of additional evidence development to address clinical uncertainties, although timeframes seem to be short to address all questions. Budgetary uncertainties are covered by different kinds of financial compensation mechanisms: percentage of turnover (71.7%), fixed amount per unit (8.5%), fixed budget (6.6%), portfolio agreements (1.9%), and combinations of different types of compensation mechanisms (12.3%). Patient based outcome schemes seem rather difficult to conclude due to logistic, privacy, financial and scientific reasons. Consensus between all stakeholders is rarely reached within the given timeframe. CONCLUSIONS: Budgetary, straightforward MEAs with only one type of compensation mechanisms are apparently preferred by payers and manufacturers. However, more sophisticated and creative schemes are possible as long as the compensation mechanism can be put on paper in an inarguably and non-interpretable manner.