It is no secret that billions of people across the world lack the freedom and right to access life-saving medicines. For decades, people have fought to put this, though, as the Covid-19 pandemic made sickeningly clear, vast swaths of humanity are still left without. The reason: people are actively denied access to affordable medicines by outdated patent rules and economic policies dominated by neoliberalism. It is no accident, and it is not due to the pharmaceutical industry alone. Tahir Amin and Rohit Malpani, two leading figures in the access to medicines movement, examine the origins of this system of rules that champions monopolies and the false god of innovation over the public interest and human well-being. They tell the story of how, move by move, governments have ceded control to and then empowered pharmaceutical companies, making it increasingly hard to undo the damage wreaked along the way. From their unique vantage points and experiences, the authors critique global health initiatives and philanthropists for maintaining the status quo and warn of a future dominated by financial markets and artificial intelligence that will reinforce the worst practices of yesterday and portends new injustices for everyone. Ultimately, Pharma Monopoly questions the foundations of international efforts to improve access to medicines and calls for a new way forward that can rekindle a movement for justice.