OBJECTIVES:: Several Latin American countries have adopted ERP as a tool to bring the cost of medicines down. Brazil and Mexico are ERP users since 2004 and Colombia since 2006. In addition, Brazil has implemented HTA in the process of determining drug launch prices. This study explored the impact of ERP, HTA (when used) and other cost-containment policies in pricing determination in Brazil, Mexico, Colombia and Argentina (which allows free pricing). METHODS:: The ex-manufacturer price (tax free; December 2016) of 24 drugs in Argentina, Brazil, Mexico and Colombia were analyzed. Of those, 12 were under direct control in Colombia (subject to ERP). RESULTS:: Argentina reported the highest prices, followed by Mexico, except for drugs that were approved before ERP implementation in Brazil, demonstrating the impact of this cost-containment measure. Colombia and Brazil featured the lowest prices, with the cheapest country varying according to the specific drug (likely due to Brazil’s inclusion in Colombia’s basket). In certain cases, when the drug was considered of public interest in Colombia, such as Glivec and Kaletra, the price of the latter managed to be up to 10x cheaper in Colombia than in the next cheapest country (and 25X cheaper than in Argentina). Moreover, among the three ERP users, different parameters (eg basket countries) resulted in substantial price differences, varying up to 220% in the case of an out-of-pocket drug. CONCLUSIONS:: The use of ERP as a successful cost-containment policy is immediately observed when comparing the prices in ERP-user countries to those in Argentina. The low prices in Brazil further reflect the impact of using a mix of ERP and HTA methodologies in price determination, which is also currently being adopted by Colombia and should bring drug prices further down in this country. Finally, Colombia achieves further reductions by using stricter ERP controls if there is public interest.