ObjectivesWhile pharmaceuticals can significantly improve the health of patients and help to mitigate health-related inequities within a population, their rising prominence within health systems is not without challenges. This paper explores health related aspects of pharmaceutical policy in Australia, Canada, Germany, the Netherlands, New Zealand, the UK and the US. MethodsDrawing on published goals for national policies, we developed a framework for gauging pharmacare system performance. We review policy structures and investigate system performance using preliminary indicators drawn from the 2007 Commonwealth Fund Survey. Survey responses to questions related to accessibility, affordability, and appropriateness are compared across countries and stratified by age, income and morbidity. Results Shares of populations reporting prescription drug use were lowest in Germany and highest in the US. Pharmaceutical use displayed expected age gradients in all countries and expected income gradients in all but Germany and the US. Cost-related non-adherence was most frequent in the US and Australia, and relatively unlikely among elderly populations. Relatively few patients reported prescribing errors, with no significant differences across countries. Out-of-pocket drug costs were highest in the US and Canada. From 1995 to 2005, pharmaceutical expenditures outpaced health care and GDP in all countries except New Zealand. Expenditure grew most quickly in the US. ConclusionThough no country appears uniformly strong in all areas of pharmacare policy, several appear to have done well to manage difficult tensions in the pharmaceutical sector.