In most countries the reimbursement and pricing of prescription drugs are regulated extensively. Central and decentralized forms of regulation can be distinguished. A central reimbursement and pricing framework grants no leeway to manufacturers and health insurers. In contrast, decentralized regulation methods permit manufacturers and health insurers on the social health insurance market of Israel and on the private health insurance market in the USA to negotiate individual contracts about prices and/or volumes of drugs. The article presents an overview, which arrangements of instruments for pricing and reimbursement dominate pharmaceutical markets internationally and analyzes the effects of these instruments.