Until the 1920s beer here was an import. The old drinks were wine and rakija, and beer was known for about a century in the trading towns of Thessaloniki, Bitola and Skopje, whose merchants dealt with the big European cities. A local beer called Alovina is recorded around 1900, and the oldest brewery on the territory, the Biraria, stood in Skopje by the church of St Petka; brewing in the Balkans then ran mostly on Czech and Austrian capital.

The first brewery to make beer for a wide market was Parna Pivara AD, the Steam Brewery of Skopje. The Czech engineer Viktor Zajs and the banker Karel Husnik founded it: its shares were subscribed on 2 September 1922 in Belgrade, and the plant went up beside the Skopje-Nis railway, because there was no brewery south of Jagodina. The first beer was brewed in August 1924 to a Czech recipe with Skopje well water. In 1925 it was licensed to supply the whole south of the country, with depots in Kumanovo, Prilep, Bitola and Strumica, and before the Second World War it made about 35,000 hl a year. The labels of the 1930s read Skopje export beer; after the war it became Skopsko. The company became state property on 27 January 1945; rebuilt in 1951 for 50,000 hl, it reached 1 million hl a year in 1985. Skopsko won silver at Monde Selection in 1978 and gold in 1981.

Prilepska Pivarnica was founded in the same year, 1924, at Cacorica in Prilep. It brewed by hand, up to 8,000 hl a year, and stopped at the start of the Second World War; it restarted in 1952 and put in a steam boiler in 1953. In 1966 forty workers made 42,000 hl, mostly dark and light Krali Marko fermented in wooden barrels, and by about 1978 output reached 250,000 hl. It has filled Pepsi since 1980. Zlaten Dab came out in 2000, and today the brewery has a capacity of 582,000 hl a year, fills Pepsi drinks and is the authorised distributor of Carlsberg and Tuborg; in 2024 it marked 100 years with a new Zlaten Dab label. The third plant, Pivara Bitola, was built in 1972 inside the agro-industrial combine ZIK Pelagonija, and in March 2000 Kenri GmbH of Basel took it over. After a bankruptcy and a Turkish owner (his Kenbach beer had a thermometer on the label), in 2010 it went to a private owner who spent over EUR 10 million on equipment, yet it hardly ever ran at full capacity, and in May 2019 it stood locked and in bankruptcy.

Ownership at the big brewery changed in 1998, when Heineken and Coca-Cola HBC together bought the majority of Pivara Skopje. In 2011 they bought a further 41.2% for EUR 79.1 million, a deal that closed on 16 December 2011 and gave them 96.5%. The brewery had become a Coca-Cola bottler in 1991, launched the dark Star Lisec in 1993 and Gorsko, a workers' beer, in 2003, the year new plants worth USD 55 million opened on 19 May. In September 2019 it brought out Skopsko IPL, its first craft-style beer. Two water and drinks firms of Kavadarci entered brewing in 2015: Kozuvcanka with Nase Makedonsko, and Koding-Gorska with the unpasteurised Starogradsko.

Small brewers began with the beer bar Old Town Brewery (Pivnica Star Grad, also called Temov) in the Old Bazaar of Skopje, which opened in 2009 and has brewed its own beer since 2015. Pivolabs followed in Skopje in 2017, and Pivara Bakrevski, a micro brewery of two brothers making BAK beer, in Bitola by January 2021. In 2021 Pivara Skopje announced a EUR 13 million project to modernise its plant, and in 2022 it marked its centenary with EUR 10.7 million of new equipment and a visitor Experience Center. BeerAdvocate lists seven breweries in the country in 2026.