Background: The Brazilian National Healthcare System relies on Clinical Practice Protocols and Therapeutic Guidelines (PCDTs) to guide patient’s journey, providing recommendations that ensure the integrality of care¹. The medicines recommended in PCDTs are included in the National List of Essential Medicines (RENAME)² and must be acquired by the federal, state, or municipal level. Municipalities are encouraged to create Municipal Lists of Essential Medicines (REMUMEs) to streamline acquisitions, but this process is decentralized, and oversight is lacking, which possibly leads to inconsistencies in medication availability³-⁴. Objectives: To evaluate the availability of REMUMEs in the 26 State Capitals and Federal District of Brazil and their conformity in offering the medicines recommended in PCDTs under municipal responsibility (CBAF). Methods: The list of medicines from the CBAF included in the 102 current PCDTs were extracted, and the 27 REMUMEs were searched for in official websites or requested by e-mail to the Healthcare Departments. Lastly, each REMUME was compared with the extracted list to measure coverage of the medicines. Results: 104 medicines of the CBAF were included in 85 PCDTs. 24 REMUMEs were collected and the 3 unavailable correspond to Aracajú, Natal and Macapá. The mean medicine coverage within REMUMEs was 60% (44% in Fortaleza - 73% in São Paulo). Five medicines, included in 8 PCDTs, were not found in any city. Of these, 3 conditions were impacted: Paget’s Disease, Precocious Puberty and Hidradenitis Suppurativa⁵-⁷. For the remaining, there were alternative treatments/dosages. Conclusions: REMUMEs are an informative resource for the population and guide medicine’s prescription/supply. Hence, their unavailability affects all Primary Health Care execution. Fragilities in the municipal pharmaceutical assistance management, like the absence of multidisciplinary committees and methodological standards for REMUME preparation contributed for none of the evaluated documents present all listed medicines³-⁴. As a result, 3 PCDTs cannot be fully implemented, 2 of those for pediatric and rare conditions⁶-⁷. Overall, the capitals do not completely meet the population therapeutic needs, affecting the implementation of national clinical protocols and healthcare journeys. 1 BRASIL, 2021; 2 BRASIL, 2022; 3 OPAS/MS, 2005; 4 Pizzol et al, 2010; 5 BRASIL, 2020; 6 BRASIL, 2020; 7 BRASIL, 2022.