OBJECTIVES: To discuss the main consequences of the implementation of the TPP agreement (TTPA) in the pharmaceutical sector in regards to public health, focusing on the accessibility and affordability of medicines. This paper also looks at the likely impact of the TPP agreement on access to affordable medicines. METHODS: Using a predetermined search strategy, we identified robust studies about the impact of the TPP on the pharmaceutical sector. Papers in the form of news, report, talks, factsheets and policy brief were excluded. Articles that discussed about the impact of TPP agreement towards public health but focusing on tobacco control were also excluded. Data was extracted, imported into Excel, and coded line-by-line. We used thematic analysis techniques to generate themes and a decision tree of the TTPA meta-synthesis. The identified themes were cross-checked against original articles to ensure consistency. We derived policy-relevant discourse from the findings. RESULTS: A total of 85 full articles and reports were reviewed and finally 32 of these were used in the meta-synthesis. Two central themes to the TTPA emerged: intellectual property rights and transparency. Five subthemes were identified under intellectual property rights: patent subject matter (representing scope of patentability); patent term adjustment for patent office delays (representing patent term extension); protection of undisclosed test or other data (representing data exclusivity); protection of undisclosed test or other data (representing patent linkage); and compulsory licensing. Meanwhile, transparency and anti-corruption-procedural fairness, which presents restriction of coverage program and reimbursement, were identified as the subthemes of transparency. CONCLUSIONS: Findings indicate that the TPPA could potentially hinder the affordability and accessibility of medicine, which could increase risks to public health. Effective approaches in handling TPPA by countries that have signed and those yet to sign the agreement will benefit all parties: the government, the pharmaceutical industry and the general public.