OBJECTIVES: With the majority of the world’s population and considerably high GDP growth rates, Asia represents a significant opportunity for commercialization of orphan drugs (OD) for rare diseases. However, despite some countries implementing policy to facilitate this process, funding for ODs remains challenging due to conflicting priorities with coverage of essential medicines. We aimed to understand the current coverage policies for ODs in China, Taiwan, Singapore and South Korea, and evaluate the impact they have on pricing and market access.  METHODS: We conducted secondary research of government legislation in each country to identify specific policy and decision making criteria for coverage of ODs and rare diseases. We also selected 8 ODs and scored them based on a pre-defined set of access drivers (incidence of the disease, severity of the condition, therapeutic alternatives, level of innovation, affordability, etc.).  Finally, we analyzed the scores to identify any correlation with the pricing and reimbursement status of these drugs in each market, and considered the influence of any identified policies on the results. RESULTS: National legislation for OD coverage was identified in Taiwan, Singapore and South Korea; however, the degree to which policy influences coverage varies considerably between countries. Additionally, in the absence of national legislation in China, provincial policies do exist, albeit infrequently and with considerable disparity. Scores for access drivers were minimally correlated with pricing and reimbursement status, however, high scores were not necessarily indicative of positive coverage; rather, affordability is the primary driver for access. CONCLUSIONS: Our results demonstrate that, although there is considerable market opportunity supported by variable legislation to facilitate OD coverage, pricing and market access remains challenging and is not necessarily related to individual product value. Therefore, pharmaceutical companies seeking access for ODs should consider selective programs, designed to improve affordability and patient access.