The pursuit of economic and clinical value in oncology goes "beyond the pill" to encompass improvements in the process of caring for patients suffering from cancer. The concept of value-based payment thus extends beyond the amounts reimbursed for drugs themselves to encompass the methods of payment used for the physicians and facilities where those drugs are prescribed and delivered. Oncology payment mechanisms vary widely across nations depending on the structure of their health care systems, but the challenges of appropriate drug selection and patient engagement are common to all. This paper describes contemporary efforts to create stronger payment incentives for appropriate drug selection, administration, monitoring, and management in the United States and France. (C) 2016 Elsevier Ltd. All rights reserved.