The purinergic receptor family is primarily activated by nucleotides and contains members of both G protein coupled-receptor (GPCR) superfamily (P1, P2Y) and ligand-gated ion channel (P2X). The P2Y receptors are widely expressed in the human body, and given the ubiquitous nature of nucleotides, purinergic signalling is involved with a plethora of molecular physiological functions. The widespread nature of P2Y receptors make them a viable therapeutic target, but with the negative risk of on-target side effects. Some of the side effects associated with P1 and P2Y receptors arise due to the pleotropic nature of many GPCRs, as a singular GPCR can activate several G proteins, as well as recruit β-arrestins. The utilization of ligands that exhibit downstream pathway-specific activation, also known as biased signalling, at the P2Y receptors could circumvent these issues. This review will cover the signalling nature and impact of the P2Y family, with an emphasis on individual activity patterns of the P2Y receptors. This review will also discuss current literature on the development of biased ligands for these receptors, with an aim to highlight the most beneficial targets and outcomes.