Spain has fewer medicines than neighbouring countries and takes longer to incorporate them. The European Union (EU) has set itself the strategic objective of improving patient access to diagnosis and treatment of rare diseases1 . However, it is to be expected that there is some heterogeneity among the EU countries as a whole, due to the fact that the organisation and funding of healthcare is a competence of each Member State. The results of this study confirm this diversity in the degree of access to treatment, something that had already been highlighted in previous research initiatives, notably in the European Organisation for Rare Diseases (EURORDIS) studies published in 2007 and 2010.