The future place of medicines in health care is both exciting and uncertain. With an aging population, an increasing number of chronic sick, a growing range of treatment options and a developing European market, the one certainty is that medication patterns will change radically over the next 15 years or so. How the future might look, in terms of quality, volume and cost of pharmacotherapy, is the subject of this report. Four scenarios for the future are set out, all of which take account of already visible trends. Sobriety in sufficiency envisages rational and restrained consumption patterns. Risk of avoidance is dominated by fears of iatrogenic harm and hence minimal drug use. The central feature of Technology on demand, in contrast, is confidence in technological progress. Free market unfettered, finally, is marked by a Europe without frontiers and minimal state intervention. The reader is encouraged to reflect without preconceptions on the future of medicines in health care. No ready-made answers are offered; rather, a wealth of information and analysis is provided which serves to underpin decision making and policy development, not just by central government but also by every institution concerned with the role of medicines in health care.