Each year more than eighteen million human lives end in death from poverty-related causes, fully one-third of all human deaths globally. This amounts to fifty thousand deaths per day from causes such as respiratory infections, HIV/AIDS, tuberculosis, malaria, measles, and tropical diseases. Many of these are treatable, if not curable, conditions. The numbers are overwhelming and mandate an examination of the barriers to accessing medicines in developing countries, where the majority of these deaths occur. Admittedly this is an immense and complicated issue, and the economics behind pharmaceutical innovation and access is but one facet of a complete understanding of the problem. This paper describes the context of the problems surrounding access to medicines, highlighting the tremendously complicated web of issues that prevent medicines from reaching the world’s poorest. The following sections provide a bit of background on pharmaceutical patents, international intellectual property law, the pharmaceutical industry perspective, and the complicated elements that come together to create the most significant barriers to pharmaceutical access. While the international patent system is obviously flawed and in need of improvement, it is overly simplistic to blame drug patents and the global pharmaceutical industry for the access problem. The reality surrounding the challenges of access to medicines is more nuanced. In the debate over barriers to access, the culprits include corruption, poverty, taxes and tariffs, and pharmaceutical counterfeiting. Section two presents the fundamentals of the global pharmaceutical market. Section three introduces the challenges surrounding access to medicines. Section four provides analysis, and section five concludes.