The PPM lies on framework agreements with pharma companies, whereby negotiated prices allow recipient (and now some transitioned) countries to avoid paying patent rights. As soon as countries have to procure medicines on their own, they lose access to negotiated prices and have to deal with pharma companies on the basis of the TRIPS agreement. An additional problem lies in commitments imposed by the EU in Association Agreements with neighbouring European countries, under TRIPS. The Agreement on Intellectual Property Rights imposed increased monopoly patent protection periods for pharmaceutical products in many countries, leading to increased pricing of HIV treatment, and in many Low and Medium Income Countries with limited health insurance coverage, to out-of-pocket payments by key and vulnerable populations, and when prices soar, to medicines becoming unaffordable to the poorest.
 The Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) is an international legal agreement between all the member states of the World Trade Organization (WTO). It sets down minimum standards for the regulation by national governments of intellectual property (IP) as applied to nationals of other WTO member nations. TRIPS was negotiated at the end of the Uruguay Round of the General Agreement on Tariffs and Trade (GATT) in 1994 and is administered by the WTO. It entered into force on 1 January 1995.