Since 2004 public provision of ARV in Dominican Republic (DR) has been funded, by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). Until 2009 there was a gross correspondence between the increase in the number of treated cases and the funding. From 2009 to 2012, however, the number of cases grew at an average rate of 33.4% (2,958 cases) per year, whereas funding experienced an average decrease of 21.7% (965,382 USD) per year. In 2012, the Ministry of Health (MoH) carried out the first national quantification exercise for the 2013 procurement of medicines, under a standard forecasting methodology. The cost of ARV was estimated in USD 6.1 million; of which the GFATM would cover USD 3.6 million (59%). This was the first time that a financial gap of about USD 2.5 million (41%) was identified and recognized by all stakeholders. A political incidence and advocacy strategies based on evidence were established for national authorities, NGO’s and international agencies to mobilize resources to close the gap. The GFATM’s principal receptor identified a new international provider of ARVs, accounting for savings of USD 910 thousand. Finally, the MoH budgeted, for the first time, USD 1.9 million for the procurement of ARVs in 2013; turning the financial gap into a surplus USD 700 thousand. For 2015 GFATM funding was 0%; however the DR Government covered a 100% of ARV needs and they have been executing USD 6.8 millions/per year. The decrease of the international financial assistance for ARV, particularly by the GFATM, can be covered by the commitment of national resources to bridge the financial gap and a more efficient use of the resources already available. The estimation of needs, consensus building methodologies, political incidence and advocacy strategies used in DR are guarantees of the financial sustainability for the following years.