(Amadeo). Canada established a Patented Medicine Prices Review Board that encourages pharmaceutical companies to suggest a price proposal for their manufactured drugs. This review board then compares the suggested price to various other countries with similar drugs. Approval is made depending on the cost of the drugs in other countries. Despite Canada’s single payer system, the country lacks universal drug coverage but due to their current system, the costs of prescription drugs in Canada remain cheaper than the cost in the United States (Morgan et al). In addition, Spain is another country that continuously aims to lower drug prices by utilizing reference pricing. Reference pricing is a system in which similar of identical drugs are categorized into a class. This allows for the insurer to pay one price for any of the drugs included within the given class. However, a pharmaceutical companies in Spain have the option of increasing drug costs thus requiring individuals to pay the difference between insurer costs and pharmaceutical company demands. Despite this, Spain has found that reference pricing often forces pharmaceutical companies to lower prices in order to maintain consumer business. Reference pricing has greatly assisted with cost-effectiveness by selling normally high-priced drugs at a reduced price (Frakt).>