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华盛顿—关于新兴和发展中国家获得平价医疗的争论常常忽视一个关键问题：这些国家的政府常常对关键性重要药品的进口课以非常重的关税。尽管这些措施能够带来稳定的税收收入，但其结果是让药价变的更贵，以至于超过了许多最需要这些药品的人的承受能力。
和发达国家一样，新兴和发展中国家的一些——如果不是全部的话——药品需要进口，这些药品的负担需要病人本人承担，因为这些国家缺少健康保险。比如，印度人的医疗支出中有70%需要自掏腰包。在一些地区，关税和其他税收将药价提高了三分之二之多，即使是最基本的非专利药，对许多最贫困人群来说也是高不可及。一份关于德里医药市场的最新报告测算，这些税费本质上是“生病税”，可以由政府出面轻松地取消。
许多新兴市场都有这一问题。根据世贸组织2012年的一份研究，阿根廷、巴西、印度和俄罗斯对进口药品的关税税率大约在10%，而阿尔及利亚和卢旺达等国家为15%。吉布提的关税税率为26%。该报告指出，很难理解为何小国要维持健康产品的高关税——这样做只能导致国内价格。
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