More than at any other time in history, science offers enormous potential to transform the prevention, diagnosis and treatment of many diseases. However, patients are urgently awaiting new therapies - and too often not getting them. And researchers and companies also face significant development obstacles as only one in ten drugs entering clinical trials ever makes it over the finish line. This article looks at the issues involved in bringing innovation into healthcare systems from a political and policy level. It takes a close look at Health Technology Assessment (HTA) across Member States, how it is working and, more to the point, how it isn't, and how it often serves to stymie the introduction of new medicines by undermining the European Medicines Agency (EMA). The article argues that the EU could strengthen HTA cooperation via a common framework, and promote higher quality and fairer assessments; while joint work could reduce duplication of efforts, and promote better synergies as well as better use of Member States' resources. The author also takes an in-depth look into criticism of private-sector pricing of innovative medicines in the light of discussions about what constitutes “value” in the context of new treatments - a discussion that shows no signs of abating - while advocating enhanced contact and the need for compromise between all stakeholders in the great value debate.