Access to medicines has been the subject of global debate for many decades and more recently during the Coronavirus pandemic. There are various contributing factors affecting such access, especially in developing and least developing countries, including Tanzania. Intellectual property rights, particularly patents, are fundamental players in this context. Often owned by large pharmaceutical companies, patents can create barriers and restrictions on fair, equitable and affordable access to medicines. The Agreement on Trade-related Aspects of Intellectual Property Rights (TRIPS) is commonly seen as having aggravated the impact of patents on access to medicines. The World Trade Organization (WTO) has acknowledged these barriers and created various adjustments to limit the negative impact of TRIPS on access to medicines: yet these are generally considered insufficient. This study focuses on the role that TRIPS plays in mediating access to medicines in Tanzania, taking into consideration the particularities of the country's post-colonial history, IP legal regime and pharmaceutical field. It examines the impact that TRIPS has had so far and finds that - although Tanzanians experience local access challenges in relation to poverty levels, the country's rural-urban divide, lack of investment in infrastructure and limited affordability of health insurance - it has added to these challenges and created further hurdles by conferring exclusive rights to patents holders. It, therefore, explores the manifestations of these hurdles and to what extent its so-called flexibilities could enable the country to address the challenges that patents pose to its population's access to medicines. It concludes that there are serious limitations to what flexibilities can achieve and points in the direction of other kinds of action that might be useful in achieving greater access.