This article is a comprehensive review of European Union and national level public enforcement actions in the pharmaceutical sector from 1974 to 2022. Whereas this research demonstrates that competition authorities are increasingly using competition law as a tool to hold pharmaceutical companies accountable in the pursuit of access to medicines goals, it also puts into question the effectiveness of such a policy by highlighting the systemic nature of anti-competitive behaviour in this sector. Indeed, using the ‘structure of crisis’ in the pharmaceutical industry, as coined by Sunder Rajan, as a framing device, this article highlights that each of these abuses is borne out of one of three drug development models that are a response to this structure of crisis: the ‘blockbuster’, the ‘nichebuster’ and merger and acquisition models. When abuses of dominance in this sector are all a response to the structural pressures arising from financialization for short-term high revenues combined with the pipeline crisis and patent cliff, is competition law intervention not simply a Band-Aid solution?