OBJECTIVES:  In developing countries, of which 55.8% are low-middle income countries, access to medicines comes at an impoverishing cost. Access is hindered by price, availability and affordability. Although developing governments have pharmaceutical pricing policies, the evidence does not always support their effectiveness in improving prices and availability. The study was conducted to identify government strategies aimed at controlling pharmaceutical prices and to assess their impact on affordability, availability, pharmaceutical expenditure and others. METHODS: Several databases, grey literature, and Google Scholar were systematically searched, and reference lists of relevant studies were screened for full-text studies published in Arabic or English between January 2000 and March 2016. Studies describing government pharmaceutical pricing strategies in developing countries and their impacts were considered eligible. RESULTS: Twenty-five studies were included in the systematic review with eighteen covering Asian countries. Eight of the studies related to China; five from African countries; and two from Latin and South America. Identified policies covered disease-specific, and essential medicines with some countries extending it to all medicine classes. External reference pricing and mark-ups regulation were the most commonly used, while tax exemptions and health technology assessment were the least used policies. Medicine prices appeared to be influenced by poor legislative framework, lack of pre-/post-implementation activities, and non-compliance by various stakeholders. CONCLUSIONS: To contain prices, governments in developing countries implemented several internationally recognized strategies, however these policies are not optimally conceptualized and enforced.