OBJECTIVES: Public expenditure on health on India is around 1% of GDP and 79 % expenditure in health of people is through out-of-pocket. Almost 30 % of the households slide into poverty due to high treatment costs and medicines. Though, India is considered as pharmacy for developing countries, yet due to poor regulatory control there is huge price variation in off-patent branded generics, even 50 times or more and leaving affordability at the mercy of prescribers/dispensers. METHODS: The Government of Rajasthan (a federal State in India with population about 70 million) has launched a scheme called Chief Minister’s Free Drug Distribution Scheme (CMFDDS) for providing free essential medicines to all irrespective of their economic status through establishing an autonomous Rajasthan Medical Services Corporation (RMSC). By well-defined transparent prequalification measures for products and suppliers, RMSC procures quality medicines through cost-minimization. Educational, managerial and regulatory strategies have been used to promote compliance by stakeholders RESULTS: Quality essential medicines are procured at unbelievable low cost compared to market retail prices, e.g. procurement cost / market retail prices for strip of 10 tablets of DICLOFENAC 50 mg, ATORVASTATIN 10 mg, GLIMEPIRIDE 2 mg, and CLOPIDOGREL 75 mg are INR 1.24/31.73, 2.98/103.74, 1.95/125.00 and 8.54/147.44 respectively (1 USD=INR 63) resulting an increase in access and equity with monthly patient inflow increased from 44,000,00 to 66,000,000 and decrease/elimination in out of pocket expenditure, as amount spent on medicines in 2 years is around INR 5,070,000,000 whereas market price of these medicines would be. INR 30,000,000,000. CONCLUSIONS: Essential medicines are not costly but are being made expensive. By utilizing the pricing information of quality medicines along with transparent pooled procurement and proper distribution system can make free access to medicines, especially underserved population with a strong political commitment coupled with the proper strategies in low resource settings.