OBJECTIVES: : In response to growing costs of innovative medicines, European countries are collaborating to improve patient access to high-cost medicines. The aim of this research was to identify and compare European cross-border drug procurement initiatives. METHODS: : A literature review was conducted complemented by ad hoc communication with experts to fill in gap of unpublished information. Publicly available resources were used such as the European Commission website, World Health organisation website, national health authorities’ websites, Medline^® database, and grey literature. RESULTS: : Thirty European countries are voluntary cooperating in pharma procurement organised within ten regional initiatives established between 2012 and 2017: Western Europe (BeNeLuxA-I), Central-Eastern Europe (Sofia Declaration, Visegrad+ Collaboration, Romanian and Bulgarian agreement), Northern Europe (Nordic Collaboration, Baltic Partnership Agreement), and Southern/Mediterranean initiatives (Valletta Declaration, Southern European+, Iberia Partnership, France-Portugal Declaration of Intent). They totally represent about 377 Million inhabitants. Valletta topped the list grouping ten countries with approximatively 159 Million inhabitants while Baltic partnership represents about 6 Million inhabitants. For most of the collaborations, main scopes of joint procurement encompass expensive and innovative medicines, while others, are focused on biosimilars and generics such as Iberia Partnership, or at joint purchasing of vaccines such as Baltic Partnership. Several aspects of drug procurement are covered including joint price negotiations, joint health technology assessment, price information sharing, and horizon scanning. Only BeNeLuxA-I initiative is confirmed to have conducted pilot assessment with pharma industry (lumacaftor/ivacaftor in cystic fibrosis). Pilots for price negotiations within Valletta Declaration may also be on-going for 2 medicines. CONCLUSIONS: : Several cross-collaboration initiatives have emerged in Europe for about 6 years to ensure sustainable access of new innovative and expensive drugs. However, noteworthy results have not been yet released. Cross-country collaborations still need to overcome legal, regulatory, political, structural and financial hurdles to become truly effective.