BACKGROUND: In 2010, the permanent national oncology-specific drug review process, pan-Canadian Oncology Drug Review (pCODR), was established to assess the clinical evidence and cost-effectiveness of new cancer drugs and provide recommendations to the provinces (except Quebec) and territories to guide their drug funding decisions. OBJECTIVES: This study sought to identify characteristics and decision patterns of the pCODR recommendations.   METHODS: Twenty-eight recommendations, covering 33 requested populations, publicly accessible at www.pcodr.ca were reviewed since pCODRs operation: 13 July 2011 - 9 December 2013.  Additional information was obtained from the www.reimbursementdecisions.com database.   RESULTS: Of the twenty-four positive recommendations for coverage, three suggested a more limited patient population than the one requested.  Four population funding requests received positive recommendations for the requested population without conditions.  In seventeen cases, positive recommendations for the requested population were made conditional on improvement of cost-effectiveness ratios.  Nine negative recommendations were made due to: a) limitations in evidence from phase two trials; b) modest progression-free survival, lack of statistically significant overall survival, lack of quality of life data and poor cost-effectiveness, and/or; c) unclear clinical benefit and an unacceptable cost-effectiveness model.  Many economic reviews by pCODR included re-analyses of the cost-effectiveness ratios which in some cases had substantial impact on cost-effectiveness.  The most common changes from the submitted analyses where limiting product benefit post-progression, time horizon reductions, or changes to post-progression mortality risk.   CONCLUSIONS: Most submissions resulted in a positive funding recommendation.  The positive conditional pCODR recommendations support a continued provincial product listing agreement structure that includes rebates to lower cost-effectiveness.  The economic re-analyses of the post-progression survival benefit indicates a need for manufacturers to provide comprehensive consideration of uncertainty surrounding such benefits in the submitted cost-effectiveness analysis.