This article assesses the impact that direct election of regional presidents has had on party politics in Italy. It finds regional presidents exert a growing personalisation of power within parties at sub-national levels, primarily through their capacity for political nomination and de facto status as party negotiators in the governing coalition. While presidents may shape structures of regional party competition, they remain constrained by coalitional politics and can struggle to assert their authority against powerful governing partners or local powerbrokers rooted in the legislature. They also possess few mechanisms to consolidate their position at national level, consistent with a broader tendency towards ‘stratarchy’ in multi-level parties. Although the distinction between densely and loosely structured parties remains relevant, a common trend towards ‘cartelisation’ at sub-national levels is noted as political parties prioritise the control of state resources and the governing legitimacy this entails. This article contributes to our broader understanding of the multi-level dynamics of party politics in Europe, as well as the unintended consequences of experimenting with an untested hybrid model of ‘directly elected Prime Minister’ in the Italian regions.