Pharmaceutical markets are characterized by barriers to entry and information problems. Many countries intervene in the pricing and reimbursement of drugs to a greater extent than the US government to date. Continued pressure from politicians and recent legislation are likely to change the market for pharmaceuticals in the United States. This article discusses the approaches adopted in other developed countries and the implications of their use in the United States, which due to its size, has far greater influence over the rate and direction of innovation. Alternative policy choices and the challenges of their implementation are also reviewed.