Chronic and non-communicable diseases are becoming a major health problem in emerging markets. Access to effective current and pipeline treatments is limited due to the high cost. Financing solutions will take time as these markets grow and develop public and private insurance systems. However, governments are faced with the immediate problem of access to treatments given limited resources. This paper lays out guiding principles for providing effective access to these treatments within the budget constraints faced by these governments. We looked at how mature markets have used HTA and other pricing and market access tools to evaluate, prioritise and provide access to treatments. We analyse IMS data on products launched since 2005 to find that these markets have broadly used three levers to manage access effectively – time to reimbursement, level of access and price.  Treatments with high value to the broad population have been provided quick open access at premium prices. Treatments with moderate value have been provided quick access to patient sub-populations; with access increasing as prices dropped. Treatments with low incremental value have either had to launch at competitive prices or faced delays or significant restrictions to reimbursement till prices dropped. While countries have used different methodologies of assessment, the outcomes have been strikingly similar. This provides important lessons for emerging markets. Currently many markets use blunt instruments such as across the board price controls, which impede effective access. We posit three principles that can help emerging markets provide effective access to medicine. First, they must use HTA to prioritise medicines. Second, this prioritization must inform resource allocation. Third, they can leverage the analysis and rationale from this prioritization and budget allocation to inform negotiations with manufacturers, which should be based on the three levers identified above – time to reimbursement, level of access and price.