OBJECTIVES: The pan-Canadian Pharmaceutical Alliance (pCPA) conducts joint price negotiations with provinces/territories and manufacturers for drugs being considered for reimbursement through public drug plans. However, not all drugs reviewed by the Common Drug Review (CDR) and pan-Canadian Oncology Drug Review (pCODR) undergo joint negotiations. This analysis examined factors that may have influenced pCPA’s decision not to negotiate drug prices collectively. METHODS: A list of the drugs not jointly negotiated by the pCPA was obtained from www.pmprovincesterritoires.ca. Final CDR and pCODR recommendation reports (publicly accessible at www.cadth.ca and reimbursementdecisions.com) corresponding to the pCPA drug list were subsequently reviewed. RESULTS: As of December 31, 2015, the pCPA did not conduct joint price negotiations for 34 drugs; 29 (85%) were reviewed by CDR and 5 (15%) by pCODR. Among CDR products, 23 (79%) received a ‘do not list’, 4 (14%) a ‘do not list at the submitted price’, and 2 (7%) a ‘list with clinical criteria/conditions’ recommendation. Uncertainty in the comparative clinical benefit of the drug was cited as the primary limitation in the majority (79%) of CDR recommendations, followed by concerns related to cost effectiveness and/or product price. All pCODR products received a negative recommendation because of uncertain/insufficient clinical benefit and uncertain cost effectiveness.  CONCLUSIONS: The majority of products that the pCPA did not jointly negotiate received negative recommendations from CDR or pCODR due to concerns regarding clinical benefit. This study highlights the value placed on robust clinical data in reimbursement recommendations and price negotiations.