The rising cost of prescription drugs in the United States has led patients---older populations and the disabled especially, to seek relief through foreign nations, and internet mail-order sites, which are often hosted and condoned by state and local governments. Patients are traveling to Canada and Mexico to purchase affordable prescription drugs. According to the Congressional Budget Office, American seniors alone will spend 1.8 trillion dollars on pharmaceuticals over the next ten years (U.S. Senate 2007, S 251). This research examines the agenda status and change of pharmaceutical regulation by tracing the evolution of the pharmaceutics subsystem. By employing a punctuated equilibrium approach, I seek to understand if periods of agenda access and issue definition have corresponded to changes in the institutional structure of policymaking.;As such, this study is motivated by three questions: (1) how has Congress governed the pharmaceutical policy agenda over the post World War II era, (2) have periods of agenda access led to venue changes in pharmaceutical regulation, (3) has the image of pharmaceutical policies led to positive or negative feedback, and if so, what factors precipitated such change. Understanding how image and agenda access can impact the institutional structure of policymaking will illustrate how ideas influence the strength and weakness of the pharmaceutical policy monopoly. The results of this study are important because they highlight the institutional factors influencing the cost and availability of prescription drugs. Moreover, this research provides insight concerning federal involvement in regulatory policy