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Many people agree our current system fails to efficiently & fairly distribute costs for pharmaceuticals (both in price itself & in distribution). Many policy solutions, very basically, provide us with new tools to alter price. One strategy is to expand negotiating power of payers (Medicare) or other stakeholders who are/will be at risk for prices (doctors in risk-bearing ACOs, patients). Payers would look at costs for the entire system, determine the best value, and set payments accordingly. At-risk stakeholders could be empowered with cost data to inform decisions (e.g. the most autonomy). A 3rd option is to build a value equation into the price of drugs themselves through more cost-effectiveness studies. However, as mentioned earlier, it is difficult to determine "value" not only because it forces us as a society to grapple with the difficult question of how we formally prioritize value in health (e.g. "death panels"). All of these options involve someone making a determination about value and is just about who does it and how. What are the most important pros and cons of these different strategies, barriers, & what do you think will prevail?