The international community is searching for ways to improve how new medicines, vaccines and diagnostics are discovered, developed and distributed. The drug discovery, development and distribution process involves a wide range of actors. The pharma originator company is profit-driven, compared with alternative models such as public-private partnerships (PPPs) and product development partnerships (PDPs), which have a substantial public or non-profit financing component. This chapter explores whether and how PPPs and PDPs should become a more significant part of the global pharmaceutical system. One approach is delinkage, aiming to pay R&D costs other than through sales and distribution revenues. It does not necessarily follow that R&D costs will decline, but removing distortions in the system due to the need to generate large profits will lead to systemic savings. Governments might establish PPP hubs to develop new drugs and make them available to generic producers. An alternative is R&D funding through privately managed insurance pools. This chapter discusses whether shifting control to models that reduce profit motivation and include more publicly oriented management would lead to better outcomes.