OBJECTIVES: There are 17 autonomous regions in Spain, which can each make distinct pricing and reimbursement decisions for medicines. In an effort to introduce more consistency, the Spanish Agency for Medicines and Health Products (AEMPS) has issued national therapeutic positioning reports (TPRs) for new medicines since 2012. These are comparative efficacy and safety reports which specify the patient population that will benefit most from any new medicine. This research aims to analyse the number, indications and outcomes of TPRs. METHODS: All publically available TPRs were screened up to 31^st December 2015 and the date, decision, drug, and indication were extracted.   RESULTS: CONCLUSIONS: The number of TPRs being issued has dramatically increased in 2015, and these reports frequently conclude that a new therapy can be considered as a treatment option but is not superior to currently reimbursed alternatives. However, the impact of TPRs has been questioned as they are not mandatory for regions to follow and do not include economic evaluations as standard, a key consideration for regional bodies, especially in the current economic climate.