This Oslo Medicines Initiative technical report presents existing policy options for payers that support innovation and access to medicines in the WHO European Region. It identifies innovation incentives, such as early assessment schemes, managed entry agreements and dedicated budgets (‎so-called innovation funds)‎, across 48 countries in the Region. These incentives are supplemented by supporting assessment tools to generate evidence for informed decision-making (‎such as horizon scanning and health technology assessments)‎ and access policies for innovation, such as value-based pricing, pooled procurement and subscription fee-based procurement. The report also points to possible limitations of the identified policies; some innovation policies can challenge the financial sustainability of health-care systems, and there are trade-offs between incentivizing innovation and principles of evidence generation, transparency and budget impact. Case studies demonstrate how two countries apply a mixture of policies to support innovation and access to medicines.