The ongoing controversy regarding how to control the cost of prescription drugs has become a source of constant political debate. This is not a uniquely American issue. For years, NICE, through its health technology assessment function, has attempted to manage the cost of therapies. But they are struggling, as we in the US are, with truly novel and potentially curative treatments. Among solutions they are exploring is the use of outcomes based contracting; and this outcomes based approach is identical to that being discussed by many commercial US payers who are doing or interested in milestone based payment or milestone based payment over time; as well as indication or combination-based pricing or models like the subscription-based model for HCV. The possibility that a similar structural format could be employed in both these payer settings will the focus of a roundtable, hosted by ADVI, in which NICE will meet with and discuss this important topic with US commercial payers on April 23 in Washington, DC.