OBJECTIVES: Access to medicines depends on four pillars i.e. affordability, adoption, availability and appropriate use. Differential/Tiered pricing, which is the adaptation of drug prices to the purchasing ability of consumers in different geographical or socioeconomic segments could be a way to improve access by making pillar of affordability stronger. This research aims to explore the current scenario and key challenges in implementation of tiered pricing for drugs in India.  METHODS: A comparative evaluation of 33 drugs has been done to explore the role of tiered pricing in pharmaceuticals medicines for HIV/AIDS, Malaria, Diabetes, Blood Pressure, Respiratory infections, Tuberculosis and Cancer in India. To get deeper insights, drugs for HIV infection are comprehensively analysed for price cut, first approval, success factor and reasons behind using the tiered pricing policy.  RESULTS: Annual health expenditure per capita of Indian population is $18 and 3.9% GDP is spent on health, 60% of which is out of pocket expenditure. HIV prevalence in India is 0.3% and 2.1 million people are living with HIV. Access to antiretroviral patented drugs have increased by tiered pricing, like Tenofovir by Gilead ($0.567/unit), Efavirenz by Merck ($0.650/unit), Indinavir by Merck ($0.270/unit), Raltegravir by Merck ($2.362/unit), Valganciclovir by Roche ($4.210/unit), Nevirapine by Boehringer Ingelheim ($0.600/unit), Lopinavir/ritonavir by Abbott/Abbvie ($0.203/unit)  and combination Tenofovir /Emtricitabine ($0.875/unit) by Gilead but generic drugs are still cheaper than the lower tiered price for example Tenofovir by Cipla priced for $0.167/unit and by Ranbaxy for $0.150/unit. CONCLUSIONS: Differential pricing is not a panacea but it can be one of the useful tools to improve the access to medicines. Although it is a win-win for both consumers and industry and can reconcile both static and dynamic costs, it has not been widely implemented so far. There is an urgent need to implement regulative and legislative framework by policymakers and lawmakers to achieve success.