Decades of research and development by the pharmaceutical industry have provided society with a treasure trove of good medicines that are available at rock bottom prices; they are called generics. However, medical needs continue to exist in the prevention, diagnosis and treatment of many diseases.  Society rightly expects that those needs will be addressed with new medicines, available at affordable prices.  On the other hand, costs for bringing a new medicine to the market have long exceeded 1 billion $. However, many drug development projects fail; if their costs are included, it has been calculated that bringing one new medicine to the market may actually cost 4 billion $. Moreover, drug discovery and development require long-term investment and each project has a high risk of failure. Investors, whether private persons or pension funds, only put money in long-term and high-risk projects if they can expect a return which is higher than with other forms of investment. Proposals to focus drug development on “truly innovative” products (a fancy term for high-risk projects) and to initiate long-term outcome studies earlier in the life cycle of a new drug (implying even greater investment before a drug is approved) will further increase the average cost of bringing a new medicine to patients. Thus, some of today’s attempts to contain medication costs may even further increase tomorrow’s prices – or risk discontinuation of drug development efforts. The ADAPT-SMART project under the Innovative Medicines Initiative of the European Union brings together regulatory authorities, health technology assessment bodies, payers, patient organizations and the pharmaceutical industry to find ways for balancing the needs of affordable prices and profitable investment in drug discovery and development.