The desperate need for a vast part of the global population to access better medicines in more certain ways is one of the biggest concerns of the modern era. Pills for the Poorest offers a new perspective on the much-debated issue of the links between intellectual property and access to medication. Using ethnographic case studies in Djibouti and Ghana, and insights from actor-network theory, it explores the ways in which TRIPs and pharmaceutical patents are translated in the daily practices of those who purchase, distribute, and use (or fail to use) medicines in sub-Saharan Africa. It suggests that focusing on routine practices and the material deployment of intellectual property significantly enriches our understanding of the complex dynamics that animate the field of access to medicines and helps relocate the role of law within those processes. It demonstrates how intellectual property affects access to medicines in ways that are often discreet, indirect and forgotten. By exploring these complex mechanisms, it seeks to ask questions about the modes of actions of pharmaceutical patents, but also, more generally, about the complexity of legal objects.