OBJECTIVES: The introduction of generic price-regulated systems in many European countries, the trend towards international generic medicine companies, and competition from Indian companies emphasise the need to gain insight into international prices of generic medicines. The aim of this study is to compare generic medicine prices in ambulatory care in Belgium with prices in other countries in 2005. The price difference between original and generic medicines in Belgium is also elicited. METHODS: Data on ex-manufacturer prices of generic medicines of 15 molecules/strengths were derived from IMS Health. Belgian prices were compared with prices observed in Denmark, France, Germany, India, the Netherlands, Norway, Spain, Sweden and the United Kingdom. Comparability of pharmaceutical form was attained by limiting the analysis to medicines in immediate-release, oral, solid dosage forms. For each molecule/strength, the average price per standard unit weighted by volume of sales of all available package sizes and generic manufacturers was calculated. RESULTS: India and Scandinavian countries had the lowest ex-manufacturer prices of generic medicines of selected molecules/strengths. The 15 molecules/strengths were, on average, 63% cheaper in India than in Belgium. The average price across generic molecules/strengths in Belgium (0.206 €) was higher than the mean price across all countries (0.190 €). The highest average price levels were observed in France (0.254 €), the Netherlands (0.260 €) and Germany (0.269 €). Ex-manufacturer prices of a specific generic molecule/strength varied between countries by a factor 3-36, depending on the molecule/strength. The price difference between original and generic medicines generally ranged from -12% for simvastatin 20mg to -62% for enalapril 5mg in Belgium. CONCLUSION: Ex-manufacturer prices of selected generic medicines varied substantially between countries. India has emerged as a low-cost producer of generic medicines. The international price comparison reveals that there may be scope for reducing generic medicine prices in a number of countries.