Since April 2010, in Belgium the financing of medicines has been associated with risk-sharing schemes through individual agreements between the payer (National Institute for Health and Disability Insurance) and a manufacturer. As part of the legal framework of the reimbursement procedure, the conditions, content and timing are transparent and clearly defined. The aim of this research is to determine the trends seen in Managed Entry Agreements (MEAs) concluded since the introduction of risk-sharing schemes in Belgium and to define which hurdles should be overcome in the future. Between April 2010 and February 2016, 133 demands for entering negotiations to conclude a MEA were analyzed according to type of reimbursement procedure, ATC code, and timing between submission and effective reimbursement. Insights in negotiation performance are based on meeting reports. Regarding medicines with an unmet medical need, a convention is concluded in 63% of orphan drug applications and 73% in case of claimed added value. A similar trend is seen for me too products for which the reference drug is reimbursed by a MEA (63% with positive result). Pharmaceuticals with ATC code L represent 51% of all MEAs, followed by medicines with ATC code B (17%). Since 2012 a decreasing trend is visible in time between the reimbursement application and entry into force of the reimbursement. In approximately 25% of all demands, no convention is concluded and no reimbursement granted. In Belgium, the increasing experience with MEAs has resulted in a budgetary more manageable and accelerated patient access to innovative medicines. However, a MEA can only be concluded if an agreement is reached between manufacturer, Minister of Social Affairs and Minister of Budget. Often conflicting interests, defense of own ‘trenches and bunkers’, and the lack of a mandate to explore alternative scenarios hinder the search for common grounds.