In providing care for the expanding older population, “What matters most?” cannot mean any therapy at any price. Aligning the
price of new therapies with demonstrated added benefits is an important step on the road to a health system that can guarantee sustainable
access to effective therapies for older patients. Policies around pricing and coverage must be developed in a transparent fashion with adequate consideration of the views of patients and families. Pricing and coverage decisions must also reflect that “high-value,” high-cost treatments applicable to large numbers of older patients will require measures to ensure that the potential budgetary consequences do not impinge on patients’ access to treatment and the affordability of their care. Widely applicable drug therapies with extremely high prices are likely to emerge for the prevention and treatment of chronic conditions that are common among the older population in the United States. The ability of the US health system to deliver innovation, value, affordability, and access will be tested as never before. For the benefit of older patients, it is time to address these important challenges