OBJECTIVES: Several jurisdictions assess the relative clinical effectiveness of new therapeutic agents compared to existing products and assign rankings of therapeutic improvement. These rankings influence and sometimes determine the potential pricing of the product in the respective jurisdiction. This study sought to compare the level of therapeutic improvement assessments in three jurisdictions and discuss the parameters leading to any differences observed in level of therapeutic improvement rankings. METHODS: Efforts were taken to standardize the level of therapeutic ranking systems of Canada, France and Germany to have comparable levels of therapeutic improvement.  We identified 128 unique substances reviewed by Canada’s Patented Medicines Price Review Board (PMPRB) between 2011 and 2013 for which level of therapeutic improvement rankings were assigned.  Of these, 18 were also reviewed by the Haute-Autorité de Santé (HAS) in France and the Federal Joint Committee (GB-A) in Germany. The level of therapeutic improvement rankings were observed in each jurisdiction to assess concurrence among the organizations. RESULTS: Preliminary results indicated that there was concurrence in the level of therapeutic improvement rankings across the jurisdictions with most products receiving low levels of therapeutic improvement (n=13). CONCLUSIONS: Overall, concurrence was observed among the agencies’ level of therapeutic improvement rankings for the 18 drugs commonly evaluated. Elements such as a review’s timing and order, the primary indication and relevant comparators identified in the therapeutic area by each jurisdiction are important to understand discrepancies in level of therapeutic improvement suggested. Discussion surrounding limitations of standardization is necessary to inform results.