OBJECTIVES: In the context of ever increasing demand and expenditure for health services it is important to identify policies which may maximise efficiency. Often, pharmaceuticals (approximately 20% of total healthcare expenditure) are a primary target for achieving efficiencies. This study aims to study the efficiency of pharmaceutical control policies. METHODS: Data on pharmaceutical policies and markets across 65 countries were collected from the published literature, with emphasis on the following domains: pricing, reimbursement, dispensing, expenditure and demand control. In each domain, policies were classified and through a multiple-country expert survey were graded for the degree of regulation. Countries were clustered according to their policy mix. Principal component analysis (PCA) served to group policies into three components: pricing policies, reimbursement policies and demand and cost control policies. Regression analysis with pharmaceutical expenditure as % of GDP as dependent variable was used to analyse the efficiency of policies. Independent variables were life expectancy, dependency ratios, mortality rates, GDP per capita and health system type. RESULTS: Spearman correlation coefficients indicated that there was no statistically significant association between total pharmaceutical expenditure as % of GDP and regulation in the coverage, pricing, reimbursement, dispensing policy and system type. A statistically significant positive correlation between regulation and indirect price and cost controls (0.334, p=0.028) and demand controls (0.333, p=0.019) implies that more regulation in these domains is associated with higher expenditure.  Following the PCA, regulation in demand control policies was associated with higher expenditure (0.342, p=0.025) and the same applies for the aggregate of the components (0.314, p=0.040). In regression analysis the coefficients (p-value) were pricing:-0.003(0.950), demand control:0.062(p=0.067), reimbursement: -0.057(0.439), mortality: 0.001(0.414), Life Expectancy: 0.062(0.474), elderly ratio: 0.689(0.774), GDP-per-capita: -1.788(0.017).  CONCLUSIONS: A variety of policies were developed recently to control pharmaceuticals. More regulation does not appear to increase efficiency or decrease expenditure.