OBJECTIVES: In Korea, as drug costs reached up to 30% of total NHIC budget and total drug expenditures doubled from 2002-2006 that leaded to increasing budget deficits, MOHW(Ministry of Health and Welfare) called for positive list system in Dec 2006. It requires pharmaco-economic evaluation and price negotiation with single payer to pharmaceutical companies. At the point of 3 year passed after this policy introduction, we try to evaluate this policy with balanced manner between its achievements and challenges. We also try to suggest some supplementary proposal to make this policy sustainable in Korea. METHODS: We analyzed 4 reports which deal with positive list system in Korea from 2007 to 2009. We also reviewed several key analyses performed by media and academic association regarding this policy in the same periods. Among these reports and the investigations, we collected main achievements and challenges raised by all relevant stakeholders from 2007 to 2009. RESULTS: The main achievements are fast development of HTA infra, the establishment of evidence based decision making and reduction of reimbursement price level comparing with negative list system. While, the key challenges raised by each stakeholder group are lack of transparency, deficiency of data support by government and price focused approach in selection of comparators. CONCLUSIONS: Our supplementary suggestions are no reimbursement guarantee in NHI for mild disease such as simple cough over the age of 13, reinforcement of health insurance guarantee level based on accurate budget forecast, financial agreement(risk share) between NHIC and company and performance based pricing.