OBJECTIVES: WITH THE EMERGENT ROLE OF COLLECTIVE NEGOTIATION BY DRUG PLANS AND BUDGET MANAGERS IN CANADA, ECONOMIC VALUE APPEARS TO BE A SECONDARY CONSIDERATION IN THE DELIBERATIONS OF PCODR'S EXPERT COMMITTEE. CLINICAL VALUE APPEARS TO TRUMP ALL OTHER CONCERNS, WITH THE KNOWLEDGE THAT THE ECONOMIC VALUE OF NEW INTERVENTIONS WILL ULTIMATELY BE DECIDED BY ANOTHER INSTITUTION, THE PCPA. WE SOUGHT TO DETERMINE WHAT EMPIRICAL EVIDENCE COULD BE DRAWN TO SUPPORT THIS HYPOTHESIS. METHODS: THE FIRST 65 RECOMMENDATIONS ISSUED BY PCODR WERE EXAMINED AND THE ECONOMIC CASE FOR EACH WAS SCRUTINIZED. WHERE THE COST-EFFECTIVENESS OF THE PRODUCT UNDER REVIEW WAS STATED TO BE UNACCEPTABLE, OR WHERE THE PUBLISHED ICER ESTIMATES EXCEED NORMAL CONVENTIONS OF "COST-EFFECTIVE", SUCH CASES WERE NOTED. THE ADDITIONAL COSTS AND EFFECTS OF NEW INTERVENTIONS WERE RECORDED, AND PLOTTED ON A COST-EFFECTIVENESS PLANE, WITH THE AIM OF INFERRING SOME THRESHOLD VALUE. RESULTS: NO DRUG SUBMISSIONS WERE REJECTED ON ECONOMIC GROUNDS WHERE CLINICAL VALUE WAS RECOGNIZED, WITH THE SOLE EXCEPTION OF A DRUG WHICH HAD BEEN MODELED INADEQUATELY. ICERS RANGED FROM $20K TO OVER $300K, BUT WERE NEVER THE GROUNDS FOR NEGATIVE LISTING RECOMMENDATIONS. CONCLUSIONS:  ECONOMIC VALUE ALONE IS INSUFFICIENT GROUNDS FOR A NEGATIVE LISTING RECOMMENDATION BY PCODR. AS LONG AS CLINICAL VALUE IS ESTABLISHED, RESPONSIBILITY FOR SECURING A COST-EFFECTIVE PRICE IS THE RESPONSIBLE OF THE DOWNSTREAM COLLECTIVE BARGAINING INSTITUTION, THE PCPA.