This chapter analyses the political economy of continuity in Mexico. High levels of patenting and accentuated transnational dominance of the pharmaceutical industry, both functions of the choices of the 1990s, created an environment that was inhospitable to efforts to reform the new pharmaceutical patent system. The chapter examines a set of revisions to the new pharmaceutical patent regime in the 2000s, all of which were resolved to the benefit of patent-holders seeking greater rights of exclusion. The analysis demonstrates that persistent over-compliance was not because of Mexico’s obligations under NAFTA, but rather despite the opportunities for tailoring that were allowed by this agreement. Within-case comparative analysis offered by these case studies provides variation on the preferences of health officials in the Mexican Executive, the interests and strategies of the local pharmaceutical sector, Mexico’s sensitivity to external pressures, yet the outcomes were similar, as a result of Mexico’s changed social structure.