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Introduction: Effective medicines exist to address global health challenges including Neglected Tropical Diseases (NTD) and Noncommunicable Diseases (NCD) however these are often unavailable and unaffordable. To date, little literature exists comparing medicine unavailability across broad disease areas. / Areas covered: Using insulin and praziquantel as tracer medicines this review aims to demonstrate that separating global health governance agendas for NCDs and NTDs ultimately impacts the effectiveness of coalitions for access for the poorest populations. Electronic literature searches were performed through Science Direct, PubMed, and Google Scholar (March–May2017 and updated in September– December2019) using keywords from Shiffman’s framework; NCDs; NTDs; and for each medicine. Best practice from each area was analyzed. / Expert opinion: Many actors responded to the London Declaration which reinforced praziquantel’s central role in control and elimination of schistosomiasis whereas access to affordable insulin emerged secondary to framing around prevention and management of diabetes. For insulin key stakeholders are not aligned around access. The position taken by pharmaceutical companies as donors versus commercial actors was critical to sustainable affordable access to these medicines. Integrated access models for low resource populations need shared pathways given the increasing need for essential medicines in the context of Universal Health Coverage.