ISSUE: Performance based risk sharing arrangements (PBRSAs) are increasingly popular in the US and have been touted as a means of achieving greater value and affordability in the adoption of new medical products. However, success is uncertain, and the challenges of good contract design and administration are significant.  This panel features a representative of a major pharmaceutical company who has been at the center of his company’s design of several PBRSAs and representatives from a large national and a regional payer who have both approached medical product manufacturers and been approached by such companies to enter into PBRSAs.  Some of these have been successfully negotiated; others not.       OVERVIEW: The moderator will provide a short overview of the state of PBRSAs in the US today. Panelist #1 will discuss the framework that his company uses in determining if and how it will contemplate undertaking a PBRSA for products in its portfolio, with which payers, and on what terms. Panelist #2 will talk about how his company decides the type of contract with which it will approach manufacturers and/or providers, for what products/services, and broad contract structure details.  Panelist #3 will relate the types of contracts that his company has been approached to enter into, what the details of negotiations have tended to be centered on, and the resulting structure of the ensuing contract or the reasons the parties could not come to consensus.  The moderator will facilitate discussion a discussion about keys to success from both sides and the general future and aims of PBRSAs in the US.  An audience question and answer session will conclude the session.  Given the proprietary nature of PBRSAs and payer/ manufacturer interactions, only information that the panelists are comfortable in revealing will be shared in the session.