While Japan used to be the second-largest drug market in the world, it was eclipsed by China a few years ago. In 2004, the Japanese market size was about 13% of the global market but 18 years later, it is only about half of that, or 7.5% of the global drug market. To change that the Japanese government initiated the Vision Plan in late 2021. This is a 10-year plan to increase Japan’s competitiveness in drug discovery, generics, and drug distribution. Included in the plan are increased government spending for drug R&D, increased licensing, an increase in the number of drugs originating from Japan, etc. However, doing so will not be easy given the fact that many drug reimbursements are going down. One new strategy that has been implemented includes the so-called Price Maintenance Plan which says there will not be any downward drug price changes if certain requirements are met. Also, please keep in mind that Japan is still one of the best markets in the world for orphan drug products as well as high-priced drugs where reimbursements are still pretty good.