OBJECTIVES: To demonstrate that in European pricing and reimbursement the benefits of the pharmaceutical industries can be optimised. METHODS: We have examined the reimbursement criteria and drug price establishments of 12 European countries: UK, Netherlands, Germany, Sweden, Norway, Belgium, Italy, Spain, France, Austria, Denmark and Switzerland. Reimbursement systems were compared across six key reimbursement criteria (clinical efficacy, cost effectiveness, budget impact, foreign price reference, public medical need, value of treatment) and classified into three categories whether a Cost Effectiveness Analysis (CEA) is mandatory, optional or absent. In parallel, two types of pricing system were identified: no pricing reference and reference pricing. We have developed a network model to demonstrate the relative monetary benefits resulting from the pricing and reimbursement systems behaviour. RESULTS: We found that majority of countries determine drug price before the reimbursement decision in order to perform a CEA. However in other countries where CEA are optional or absent, reimbursement decisions generally precede price negotiations. The most important aspect of pricing for all countries except Germany and UK is the price in other reference countries (e.g. the price in France is the average of Spain, Italy, Germany and UK drug prices). Therefore a higher price obtained in Spain could increase the French drug price. Other countries (like Belgium or Italy) set price according to specific country. Pragmatically each country has its own fixed budget allocated to different diseases; therefore a reimbursement and price determination across Europe should be approached strategically to optimise margins and benefits. CONCLUSION: The applications of CEA for decision making have progressed in European countries constraining prices and costs to effectiveness. Nevertheless, in other countries drug prices are more sensitive to public health and are negotiated with public authorities. A European national pricing and reimbursement approach by disease network model could generate optimal monetary benefit for the pharmaceutical industry.