Access to medicine is at the forefront of multilateral debates surrounding the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPs). This paper argues that bilateralism allows the United States to circumvent these debates and to set standards that serve and protect the pharmaceutical industry. In addition to the TRIPs requirements, recentlyconcluded US Free Trade Agreements (FTA) prescribe the patentability of new uses of known medicines, strengthen the protection of undisclosed data, extend the term of protection to compensate administrative procedures, prohibit some exceptions to the conferred rights, define circumstances for compulsory licensing, proscribe the doctrine of international exhaustion, and restrict the grounds for revocation. Although these “TRIPs-plus provisions” are not incompatible with the Doha Declaration on Public Health, they are additional barriers for the entry of generic medicines.