The pharmaceutical industry is responsible for a large proportion of R&D investments on which the availability of future innovation depends. But there are areas facing a serious threat of underinvestment in R&D such as rare diseases. Policy makers have deployed specific tools to address this, such as the Orphan Disease legislation in US and EU. However, still much remains to be understood about the implications of these in the curent trends. I have been please to discus the main issues related to the misalignment between private and societal incentives, with my colleagues, Paolo Pertile (University of Verona, Italy) and Setti Rais (Hospinnomics, Paris) at the EuHEA biannual conference held by the Maastricht University on July 12-14, 2018.