As healthcare budgets are continuously rising in Europe, governments implement a wide variety of policies to control them. Reference pricing is a popular tool for governments to contain pharmaceutical expenditures, as 22 European countries have implemented this system. This article evaluates the impact of reference-pricing systems on drug use, drug prices, drug expenditure and health outcomes. In addition, two case studies, one for statins and one for proton-pump inhibitors, were carried out. Reference pricing drives down prices of drugs subject to the system and the use of these drugs has increased. Reference pricing creates short-term savings but the long-term growth of drug expenditure has not been reduced by reference pricing. Health outcomes of patients were not negatively affected by the system.