The high cost of pharmaceuticals gets a lot of public attention, but that is only the endpoint of a long pipeline that moves drugs from the laboratory, to clinical testing, to approval, and into the marketplace. In the era of precision medicine, we urgently need a system that supports the development of innovative therapies at every step — but just as urgently, we need strategies that allow consumers to gain access to them at reasonable prices. Eminent health economists look into the heart of the drug discovery framework and answer the question patients care most about: Can the system work better so we can pay for the therapies we need?