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This paper explores Japan’s role in reshaping the global pharmaceutical intellectual property regime by examining its position on the expansion of intellectual property rights (IPR) in negotiations for two regional trade agreements: the Trans Pacific Partnership Agreement (TPP) and the Regional Comprehensive Economic Partnership (RCEP). Through systematic analysis of leaked negotiating texts documenting its positions on key issues, we demonstrate Japan is now playing a pivotal role in promoting the adoption of expanded IPRs. We show that its position as IPR champion in the Asia Pacific region reflects a domestic strategy initiated in 2013 to bolster pharmaceutical export growth. Drawing on past experience and focusing on the RCEP negotiations, we explore ways in which low and middle income countries might respond to this shift in order to protect and promote access to medicines.