OBJECTIVES:: In Mexico oncology drugs for use in the public setting are acquired by the different public institutions, while in Brazil, the Public Health System reimburses institutions for most of treatments that are provided. Coverage in the private setting is determined by the contracted plans and, in Brazil, a minimum coverage is established by law. Here, we analyze how different policies influence access to treatments for different oncology diseases across the public and private settings. METHODS:: Approximately 200 oncologists involved in the treatment of colorectal, prostate, breast and non-small cell lung cancer were surveyed regarding access to oncology therapies on their countries between 2016-2017. Additionally, 12 payers who influence patient access to treatments at an institutional, regional or national level were also interviewed. RESULTS:: Differences in access between patients from the public and private settings were significant. For the same drug for colorectal cancer, 41-56% of public patients did not receive it due to budgetary/reimbursement reasons, in contrast to 20-27% in the private setting. A similar pattern was seen for drugs used in the treatment of other indications (30-70% versus 15-40% in the public and private setting, respectively). The reimbursement mechanism in Brazil, and the high cost of drugs in both countries were identified as the major limitations for wider access to treatments. As a result, a higher percentage of patients not receiving treatment or only receiving chemotherapy/older therapies is seen among public patients, while access to more advanced therapies is more common in private plan patients (for example, 2-20% versus 5-30% in prostate cancer). CONCLUSIONS: Access to oncology drugs in the public setting is heavily shaped by payers’ policies. Access to more advanced, and expensive, current therapies is mostly done in the private setting, and access to emerging therapies will likely follow the same pattern.