Public procurement of medicines has the potential to improve patient access to medicines. While the European Union (EU) and individual countries provide an extensive legal framework around procurement with the aim of promoting a competitive market (e.g. through open calls for tenders), it is unclear how public procurement procedures are organised in European countries and how these systems perform. We aimed to review the organisational set-up and practices for public procurement of medicines in Europe and to develop an empirically based taxonomy of public procurement systems.