Pharmaceutical systems are a core part of health systems, and their failure to work adequately severely undermines the performance of the entire health system. The view that medicines are mere commodities managed for technical aspects by the national regulatory authority, disregards the role and need for a comprehensive and multidisciplinary system to ensure access to essential medicines. This has serious consequences, as it leaves key functions underfunded and under-represented in national and international platforms where decisions related to health care systems and for achievement of UHC are made. Key strategies to strengthen pharmaceutical systems have been extensively described, but their effective implementation requires political commitment, institutional oversight and adequate financial allocation to each function, including quality assurance, financing, supply and transparency among others. Assessing pharmaceutical systems is often neglected but essential for promoting an effective health system as well as population health. The Chapter presents some key performance measures that countries should routinely apply to measure and report on the performance of pharmaceutical systems and on their good governance.