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Brazil is among the approximately 100 countries that recognize a constitutional right to health that includes access to medicines. All over Brazil, patients are turning to courts to access prescribed medicines. Although lawsuits secure access for thousands of people, at least temporarily, this judicialization of the right to health generates intensely complex sociomedical realities and significant administrative and fiscal challenges that, officials argue, have the potential to widen inequalities in health-care delivery. In this article, we explore how right-to-health litigation became (in the wake of a successful universal AIDS treatment policy) an alternative pathway for Brazilians to access health care, now understood as access to medicines that are either on government lists for pharmaceutical distribution or are only available through the market. Is the judicial system an effective venue to implement socioeconomic rights? Which practices of citizenship and governance are crystallized in these struggles over drug access and administrative accountability?