The number of cancer therapies is increasing. Treatment costs, largely reflecting increasing prices, are also increasing. The regulatory process is increasing in intensity. Countries have initiated risk sharing agreements and/or special cancer funds to accommodate this expenditure growth. Given increasing pressures elsewhere on healthcare budgets, even this response is not sustainable. With many more cancer drugs in the pipeline and the prospects of combination therapy, it is unlikely that the existing policies being applied by payers can maintain budget constraints. Unless payers increase reimbursement and/or extend flexible reimbursement schemes, solutions will be required to ensure access to new cancer therapies - this includes looking at ways of reducing R&D costs. This perspective outlines the problems faced and suggests some solutions.