AIM: To perform a comparative examination of the drug reimbursement systems in 16 secondary markets in Central and Eastern Europe, Africa, and Middle East. METHODS: The results of this study are derived from published literature and through interviews with key opinion leaders and reimbursement officials in each of the 16 countries. The reimbursement system in each country is assessed by using a set of predefined criteria. Specifically, the criteria aim to investigate whether there is public reimbursement of pharmaceuticals in the country, to identify whether a formalised review process for reimbursement application exists, whether or not a pharmacoeconomic evaluation is required in the reimbursement application, and to determine if a reference pricing system is implemented in price determination for new pharmaceuticals. These criteria will allow an understanding of the types of reimbursement systems in these countries and identifies trends in drug reimbursement policy. RESULTS: A majority of the countries considered in this study had some form of public reimbursement system for pharmaceuticals. Notable exceptions include middle-eastern countries where reimbursement is restricted to inpatients, while private health insurance is more prevalent in countries like South Africa and Russia. Very few countries, however, have an established formal reviewing system for reimbursement applications. Reference pricing was common in these markets. Several countries are in the process of introducing formal pharmacoeconomic requirements. CONCLUSION: The main concern of reimbursement authorities in these countries is containment of increasing drug costs. Several countries are increasingly formalizing this process.