As global spending on drugs increases, one of the priorities for national health systems is how to control the cost of drugs and ensure that residents get the drugs they need promptly. Performance-based risk-sharing agreement (PBRSA) is a reasonable tool to reduce uncertainty about innovative drug and to ensure access and affordability for the residents.Through systematically analyzes and compares the background, approach, and effect of implementing PBRSA for drugs in Australia, the UK. and Italy. In data collection, agreement development, drug evaluation and information disclosure, it proposea policy implications for implementing drug PBRSA in China.