This project will provide insights from international reference pricing approaches to inform implementation in the United States and will consist of two phases. The first quick turnaround phase will provide an overview of global approaches to reference pricing, including the mechanics and trade-offs of varying systems and implications for adoption in the U.S. During the second phase, the team will conduct deeper analyses of reference pricing in Canada, the Czech Republic, and Switzerland, with a focus on challenges and barriers to implementation, unintended effects, lessons for the U.S., and a quantitative analysis of impact. Data will be obtained through review of peer-reviewed and grey literature and key informant interviews for qualitative portions. Data will be sourced from publicly available sources such as the Organisation for Economic Co-operation and Development, the World Health Organization, and health technology assessment agencies, and include information on pricing of individual pharmaceutical products over time.