OBJECTIVES: Pharmaceutical patents have been a useful instrument to promote innovations in some fields. The signature of the TRIP agreement by the World Trade Organization (WTO) in 1994 has implied the generalization of a strong patent system. The objectives of this study is to review some existing alternatives to patents that may both reduce their negative impact in the accessibility to new drugs of patients from less developed countries and promote research in neglected diseases. METHODS: We have reviewed the literature on this field and identified different alternatives proposed by international institutions as well as by non governmental organisations. We describe the options and assess their potential impact on public health. RESULTS: There are several proposals: i) the intensive use of exceptions and flexibility conditions of Doha´s Declaration, especially, compulsory licensing, ii) the volunteer licensing through the “patent pool”, iii) GSPOA initiative that targets the identification and assessment of priorities dealing with R&D referred to diseases prevalent among the developing countries, iv) the approach based on prizes, aiming to incentive innovation through competition by separating the cost of R&D and the price of the drug; v) the Advance Market Commitments to ex-ante obtain the commitment to fund through donations the new agent once it has been developed, and vi) the Priority Review Vouchers that provides incentives to invest in drugs for neglected tropical diseases by offering a transferable voucher to the pharmaceutical firm that allows a priority review process for the authorisation of another agent. CONCLUSIONS: Most of the solutions are partial and do not pursue a radical change in the current patent system. In spite of these proposals, there are still many diseases with no treatment as the market does not guarantee a return.