OBJECTIVES This study aims to assess the extent of the restriction on access to medicines in Bosnia and Herzegovina in relation to the country’s decentralised provision of healthcare, with three separate state entities and 10 cantons within the federation of Bosnia and Herzegovina all having a role in the provision of public healthcare.  METHODS A comparison was made between the contents of the federal essential drug list and the drug lists of the various entities and cantons, in order to ascertain which medicines were available, at what price, and with what level of reimbursement.  RESULTS The federal essential list contains the basic INNs which must be provided by each canton, but there were some important differences between the lists of the various entities and cantons. For example, the range of patented and originator medicines available in the Republic of Srpska was greater than in the cantons of the federation of Bosnia and Herzegovina in general. Also, within the federation, there was some variation in the price of medicines between cantons, and an even greater variation between the reimbursement levels paid for them. For example, in the Tuzla canton, a package of generic losartan produced by Krka was priced at 9.30 convertible marks and reimbursed at 20% by the canton’s health insurance fund, while the same package at the same price was reimbursed 50% in the West Herzegovina canton. CONCLUSIONS The lack of  centralised control over drug funding means that citizens face variability in access to medicines across the spectrum, depending on which entity or canton they live in. Recent regulatory changes aimed at bringing greater control into drug pricing have so far failed to have any notable impact.