OBJECTIVES BRIC countries have pharmaceutical market sizes which potentially may outstrip even the largest European countries in the next decade if the growing middle classes and increased healthcare awareness continue to drive demand. This positive change has led to a shift in focus for the proprietary pharmaceutical industry, which has begun seeking new relationships with these markets. However, while governments are prioritizing health care investment, shortages still exist in basic public sector provision. Funding limitations affect local payers' perception of the value of newer, innovative products. To help address this, some pharmaceutical companies have suggested models which could lead to a rapprochement on access to newer medicines, such as investing a fixed percent of profits from branded sales profits into local economies. These new ideas could change the face of how pharmaceutical companies and payers have traditionally interacted. This research investigates how government and industry plasticity may affect the balance between innovation, affordability and accessibility in developing markets. METHODS Review of changes in pharmaceutical and healthcare figures in specific emerging markets (Argentina, Brazil, Mexico, India, Russia, China) highlighting the impact of economic change over the last decade. Review of access to branded pharmaceuticals in the private and public sectors of these markets. Review of literature on recent business model changes proposed by selected pharmaceutical companies to encourage public access to branded pharmaceuticals in these markets. RESULTS Only a handful of markets such as China and Russia have systems in place to financially reward pharmaceutical innovation. The remaining markets will be more dependent on industry leadership if greater access to new drugs is going to be possible. CONCLUSIONS To rationalise changes in policy, governments may require stronger economic arguments to prioritize investment in higher-cost pharmaceuticals than those currently being suggested.