High drug prices have seized headlines, angered patient advocates, and prompted congressional hearings. Many causes have been suggested — among them, a fragmented pharmaceutical market that limits competition, the quest for profits (whether to fund expensive R&D or otherwise), and government regulations that bar Medicare from negotiating prices. Harder to find are solutions for patients who cannot afford their therapies. Venture capitalists may be a unique leverage point on the system because their investments can encourage risk-taking and the development of novel, high-impact medicines, shifting the locus of industry’s search for rewards. How do we encourage a drug-development system that innovates, while keeping lifesaving therapies affordable?