OBJECTIVE: To understand how pharmaceutical companies and payers are approaching the affordability and willingness to pay challenges of combinations of high value high cost oncology drugs METHODS: A targeted literature review was undertaken of provisional and final HTA recommendations, and other payer / pricing and market access assessments, of “cancer stacks” (cancer drugs used in combination with one or more additional cancer drugs), reported in the public domain from 2014 to 2016. The review focused on payer awareness and understanding of new treatment paradigms and their implications for oncology budgets, assessment time horizons; and the market access solutions being proposed by both payers and manufacturers including cost shifting, cost and risk sharing, payer/pharma partnerships, and pharma/pharma collaboration. RESULTS: Payer understanding of new approaches to treating cancer (immunotherapies, precision medicines, and anti-body drug conjugates) and their multifactorial consequences is low. Payer awareness of future pressure on budgets triggered by the arrival of high profile cancer immunotherapies is high. At the national level the high prices of established products are an access barrier to new cancer stacks that include those products. At local/regional levels there is limited growth in annual budgets that would facilitate implementation of solutions agreed at the national level. Solutions include “Ring Fencing” (Indication-based Pricing, Value-based Pricing, and Personalized Reimbursement Models), Treatment Sequencing Assessment, Value Frameworks, and “Innovative Collaborations” between manufacturers, and between manufacturers and payers. CONCLUSION: There is a trend towards “co-dependency” in solution (co-dependent pricing / reimbursement / access). Future success may require negotiations that involve the manufacturers of all the products in the “stack” with the goal of “shared pain equals shared gain”. Implementation challenges will need to be overcome. Further research is required in this area.