Given the pharmaceuticals budget is proportionately one of the largest items (if not the largest) in health expenditure for most developing countries, boosting the institutional, informational and human resource capacity of payers, hence strengthening the demand side, is a condition for countries reaching and sustaining Universal Coverage. As Dr Marquez sets out in his timely blog, current weaknesses in the way pharmaceuticals are selected, procured, priced, listed/reimbursed and used in routine practice, in the public sector, is hardly an argument for doing away with an attempt to strengthen the ability of public payers better to perform these functions. As countries such as India, China and Turkey spend more public money on buying healthcare for their populations, the role of accountable, scientific, transparent and defensible processes is becoming more (not less) important. The role of Thailand's Health Technology Assessment agency (HITAP) in helping select essential drugs and vaccines for their Universal Coverage package, is a case in point. Similar work in enhancing the allocative efficiency of decisions is taking place at central and local levels in India (through its insurance and tax-funded schemes) and rural China. Colombia through IETS is also on the same track. And the British National Health Service is a case in point too with the work of NICE with regard to the adoption and diffusion of new and also existing technologies.