This chapter explores the evolution and main characteristics of the intellectual property (IP) regime and its impact on access to medicines and the right to health (RTH). The Trade Related Aspects of Intellectual Property Rights (TRIPS) Agreement poses several threats on access to medicines and the RTH. All TRIPSplus and TRIPSextra provisions delay the production of generics and hinder access to affordable medicines, especially by the poor and in developing countries, thus undermining the progressive realisation of the RTH. The chapter discusses the attempts at gaining policy coherence between global health and the IP regime to advance access to medicines and global health. The IP regime encourages a process of ‘evergreening’ patents through artificial improvements which keeps prices high whilst few new treatments are developed. Through an IP rights lens, it could be argued that a Compulsory licensing granted for public health reasons for domestic use or for export needs to be compensated as it represents an investment expropriation.