OBJECTIVES: Pharmaceutical cost containment policies can affect access to medicines. The present study compares medicines licensed in the United States (US), United Kingdom (UK), Australia and New Zealand (NZ), and subsidized by the US Department of Veterans Affairs National Formulary (VANF), UK National Health Service (NHS), Australian Pharmaceutical Benefits Scheme (PBS) and NZ’s PHARMAC.  We compare licensed and subsidized medicines in terms of: (i)  total numbers of entities (unique ATC codes), (ii) times since first registration (“age”) of entities, and (iii) numbers of innovative entities. METHODS: All products listed in a major prescribing reference text in each country were classified by ATC code and their registration dates recorded. Innovative entities given “fast track” approval by the US Food and Drug Administration or “breakthrough or substantial improvement” status by the Canadian Patented Medicines Review Board were identified. RESULTS: Of the 918 entities and 64 innovative entities licensed in the US, 505 and 20 respectively were VANF subsidized. In the UK, this was 1020 and 58 (1016 and 58 NHS subsidized), Australia 879 and 49 (567 and 30 PBS subsidized) and NZ 765 and 39 (503 and 19 PHARMAC subsidized). With the exception of the UK, US licensed entities were “newer” than elsewhere: US median “age” 6,607 days (VANF 8,203 days, p <0.001), UK 7,319 days (NHS 7,319 days, p 0.903), Australia 7,795 days (PBS 8,065 days, p 0.406), NZ 8,936 days (PHARMAC 10,724 days P<0.001). NHS subsidized entities were “newer” than elsewhere. In the US and NZ, subsidized entities were significantly “older” than licensed entities.   CONCLUSIONS: Different pharmaceutical cost containment policies appear to impact the number and “age” of licensed and subsidized entities, along with access to innovative entities. The New Zealand system had the strongest cost containment levers, but subsidised the fewest and “oldest” entities, and fewest innovative entities.