OBJECTIVES: The objective of this study was to analyze the impact of imposed and/or withdrawn economic sanctions on various countries on access to innovative pharmaceuticals, market access, and health outcomes. Recent geopolitical and pharmaceutical market dynamics related to Russia, Cuba, and Iran. METHODS: This study examined the current health care financing options and market access implications of pharmaceuticals in Russia, Cuba, and Iran in light of the introduction or removal of sanctions on these markets. Intellectual property regulations, healthcare financing and procurement options, and domestic R&D investment were the key metrics evaluated in this research. RESULTS: Due to sanctions imposed, Russia has pivoted from nearly solely an importation pharmaceutical market, to developing relevant policy framework to provide preferential access to locally-manufactured products (both from foreign and local manufacturers). Cuba, with one of the highest life expectancies in the world, has invested heavily in domestic R&D and generics manufacturing in response to the U.S. embargo, and has been successful with achieving marketing authorization in multiple countries for its biopharmaceutical products. In Iran, international sanctions have led the government to encourage domestic production, which supplies 70-90% of the market. A possible relaxing of sanctions pending a deal on Iran’s nuclear program may pave the way for a multinational presence and increasing access to life-saving medicines. CONCLUSIONS: In general, the lifting of economic sanctions is observed to have positive impact on innovative pharmaceuticals, from both market access and technology transfer perspectives. The imposition of sanctions, however, may open the opportunity for local manufacturing and industrial innovation.  Regardless of commercial and broader economic consequences, the lack of access to innovative pharmaceuticals may compromise optimal health care delivery in those affected countries.