The value equation can be very different for patients with various conditions in different countries around the world. What makes a drug valuable may vary significantly; this is especially true for patients living with rare conditions. Seemingly small or incremental improvements can be very significant for someone living with a condition that has no other treatment or lacks a sufficient standard of care. How can value frameworks better consider the needs of these populations when assessing a drug's value? Can value assessment be done well without the QALY? Who should be part of the evaluating committee, and what should they be looking for? This panel will bring together perspectives from a patient (to be confirmed), a health economist from a value framework, and a drug developer, to discuss how frameworks could better analyze the value of therapy that might be the only hope for some patients.