OBJECTIVES: Almost every Central Asian (CA) country, regulatory and reimbursement authorities increasingly require pharmacoeconomic evaluation, as part of a formulary listing or reimbursement submission. A budget impact analysis (BIA) estimates fiscal consequences of adopting a new health technology or intervention within a specific health context. Rapid benefit assessment (RBA) as a basis for central price regulation planned to introduce for new drugs in Kazakhstan. The objective was to investigate the converging trends in the BIA requirements in the CA countries  and to compare them with the situation in Kazakhstan. METHODS: We conducted a survey of requirements for the pricing and reimbursement process of pharmaceuticals in 5 countries (Kazakhstan, Tajikistan, Kyrgyzstan, Uzbekistan, Turkmenistan). Where needed informal stakeholder interviews were used to supplement lacking information. RESULTS: Increasing accessibility and affordability of healthcare services have been considered as important policy objectives in Kazakhstan. In the recent years, because a vast national drug formulary and state benefit outpatient drug program, there are problems with drug provision, cost of medical expenditure is rapidly growing and becoming increasingly unaffordable. Opportunities in all CA countries result from increasing affluence and life expectancy and the diseases associated with these. Some challenges to market access are: poor IP protection, protectionist measures, compulsory licensing, drive to use generics or biosimilars, often produced locally, price controls, variable health insurance/NHS coverage, and limited budgets for prescription drugs. Although demand for new drugs is increasing in these markets, protectionism measures, competition from generics and budget constraints due to the increased burden and requirement for new high priced drugs present a challenge when accessing the pharmaceutical market in CA countries. CONCLUSIONS: All of the investigated countries request no BIA from a payers perspective the drugs impact on the change in medical resource consumption is analyzed as part of the pharmacoeconomic and comparative effectiveness analyses.