With an ageing population, an increasing number of chronic sick, a growing range of treatment options and a developing European market, the one certainty is that medication patterns will change radically in the future. How the future might look, in terms of quality, volume and cost of pharmacotherapy, is the subject of this report. Four scenarios for the future are set out, all of which take account of already visible trends. Sobriety in sufficiency envisages rational and restrained consumption patterns. Risk of avoidance is dominated by fears of iatrogenic harm and hence minimal drug use. Free market unfettered, finally, is marked by a Europe without frontiers and minimal state intervention. The reader is encouraged to reflect on the future of medicines in health care.