OBJECTIVES: To determine the influencing factors and main principles of regulatory and policy framework in the pharmaceutical wholesale and retail system to identify good practices for adaptation in Central Eastern European (CEE) countries. METHODS: A comprehensive literature review in the scientific and grey literature and a series of expert interviews were conducted to identify influencing factors in three major categories: general political, business economic and health policy principles. RESULTS: Regulatory and policy framework related to the pharmaceutical wholesale and retail system is influenced by multiple stakeholders with different interest. Health policy demands timely access to high quality medicines to maximise health gain for the population with respect to equity. Budget constraints necessitate public need for a sustainable and efficient pharmaceutical distribution channel. To overcome these constraints, pharmaceutical wholesalers and pharmacies have to improve operational efficiency by taking into account economies of scale/scope; or positive synergies of horizontal and vertical integration. According to general political objectives policy makers may choose from 1) regulated vs. liberalised system, 2) with monopolistic vs. competing wholesalers and community pharmacies 3) with national vs. international, and 4) public vs. private ownership. Pharmacists may consider the provision of advanced health care services besides the traditional logistic activities to intensify professional influence on health policies. CONCLUSIONS: Evidence base of policy and regulatory framework related to pharmaceutical trade can be improved based on comprehensive review of scientific evidence on major principles to harmonise different objectives of stakeholders. However, publications with relevance to CEE and in general lower income countries are very limited.