OBJECTIVES: Due to increasing health care cost containment pressures in the United States, various evidence-based evaluations are in development that can be used to influence reimbursement coverage decisions. Since a wide range of different models exist for pricing and reimbursement (P&R) evaluation of drugs internationally, we aimed to compare clinical evidence-based ratings (CEBR) and cost-effectiveness ratios (CER) between the Institute for Clinical and Economic Review (ICER) in the United States (US) and key systems in the ex-US markets. METHODS: A targeted literature review was conducted using six published ICER reports as a reference document to extract corresponding forty-nine HTA reports in France, Germany, Australia, Canada, and the United Kingdom (UK) in diabetic macular edema (DME), heart failure, hepatitis-C, hypercholesterolemia, multiple myeloma, and non-small cell lung cancer (NSCLC). RESULTS: For CEBR analysis, similar ratings were seen for drugs evaluated in NSCLC (high: immuno-oncology drugs, low: non immuno-oncology drugs), hypercholesterolemia (low) and DME (low), whereas variations were seen in CEBR between countries for remaining drugs in heart failure, hepatitis-C, and multiple myeloma. For economic comparisons, ICER reports CER for 22% (2/9) drugs below a threshold of $100k/quality-adjusted life year (QALY) and 56% (5/9) below a threshold of $150k/QALY. For the same indications evaluated by ex-US HTA agencies, there was a high variation in terms of overall final positive recommendations [Australia: 67% (4/6), Canada: 63% (5/8), and the UK:100% (8/8)]. Similar observations were made for assessments where the CER was below/equal to literature-based threshold [Australia (AUD 45k-75k /QALY): 83%, Canada (CAD 50k/QALY): 25% and the UK (£30k-£50k/QALY): 37%]. CONCLUSIONS: Many ex-US markets continue to use a structured approach to influence P&R decisions at a national level. Although ICER uses value-based approach by conducting clinical and economic assessments to evaluate drugs, their decisions are currently non-binding and their role in informally/formally influencing reimbursement coverage requires further research.