Medicines are among the most common and important health care interventions. Most high income countries have implemented reimbursement systems, to ensure economic access to necessary medicines. This study aimed to examine the features of pharmaceutical systems in Finland and New Zealand, and how they translate into affordability-related outcomes. The study found that the Finnish system provides a wider choice between reimbursed therapeutic options, and faster availability of new innovative medicines. However, medicines were subject to higher patient payments, which had inequitable effects. Within the New Zealand system, patient payments are generally low for most health needs, but the choice between therapeutic options is narrower and the availability of new innovative medicines lower. Despite the narrow range, the utilisation of non-reimbursed medicines was rare among older people and did not seem to have a socioeconomic gradient.