This review aims to assess the real- world availability of targeted therapies and immune checkpoint inhibitors (ICIs) for non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) in the Federation of Bosnia and Herzegovina. Over the past two decades, treatment has become increasingly driven by tumour biology, with biomarker-guided therapies significantly improving outcomes. However, access to these therapies remains uneven and limited, particularly in developing countries. We analysed the availability of approved, reimbursed, and clinically accessible therapies in the Federation of Bosnia and Herzegovina. Additionally, a comparative assessment was performed with selected countries in the region, including Croatia and Serbia. Targeted therapies and ICIs have demonstrated substantial improvements in survival outcomes and quality of life. In the Federation of Bosnia and Herzegovina, targeted therapies are available for a limited number of molecular alterations, including erlotinib, crizotinib, alectinib, and lorlatinib for first- or later- line treatment of advanced NSCLC. Among ICIs, pembrolizumab is available in first- and second-line settings, while atezolizumab is available in second-line therapy for advanced NSCLC. Immune checkpoint inhibitors are currently unavailable for SCLC. Overall, only six of the 42 European Medicines Agency-approved systemic therapies for lung cancer (14.3%) are currently available in the Federation of Bosnia and Herzegovina. Access to contemporary systemic therapies for lung cancer in the Federation of Bosnia and Herzegovina remains substantially below current international standards. Expanding molecular diagnostics, accelerating reimbursement of therapies with the greatest clinical benefit, and strengthening the national oncology infrastructure are essential to improving patient outcomes and reducing disparities in lung cancer care.