Cost-effective medicines to treat noncommunicable diseases (NCDs) are available and in mostly low cost generic forms although they remain inaccessible and unaffordable to many who need them especially in low- and middle-income countries where the prevalence of NCDs are increasing. Scaling up access to NCD medicines is critical to global efforts to ameliorate the burden of NCDs and also in achieving the millennium development goals (MDGs). However, challenges to scaling up access to NCD medicines reflect each country’s situation and need to be addressed in a country specific way to achieve sustainable and equitable accessibility. This can be achieved by a combination of policies and programmatic options suited to countries’ situation. Concerted global efforts are important for improving access to NCD medicines and the emergence of a NCD global health initiative (GHI) could be a viable platform. Governments, in collaboration with the private sector, should give greater priority to treating chronic diseases and improving the accessibility of medicines to treat them. Important mechanisms for providing sustainable access to NCDs include efficient procurement and distribution of these medicines in countries, establishment or the provision of viable financing options, generic promotion policies and the development and use of evidence based guidelines for the treatment of NCDs.