OBJECTIVES: This study aims to determine the level of consensus that exits amongst experts on the most likely actions to be implemented to enable equal access to Orphan Drugs (OD) and specialized care to Rare Disease (RD)  patients’ in the public health sector in Spain. METHODS: Two-round Delphi survey; RD experts identified by the study scientific committee. The questionnaire [32 statements related to OD price and reimbursement (n=5); access to OD and specialized health care (n=19); RD registry (n=7); care model for RD (n=1)] was based on a literature review and 2 focus groups. Agreement was sought on the desire (D) and prognosis (P) for each statement to occur over the next 5 year. Consensus was reached when 75% participants, or more, choose the totally or partially agreed options (agreement), or the totally or partially disagreed alternatives (disagreement). Descriptive statistics were applied. RESULTS: