In the eight years since the passage of the 21st Century Cures Act, patient involvement in drug development has exploded. Millions of families affected by serious conditions, particularly in rare disease, now have time-tested paths to follow in their pursuit of a life changing treatment. But patient-focused drug development meetings (PFDDs) are only part of the story. In fact, different paths in drug development have emerged as varied as the challenges that patients themselves face every day. This session will explore different roads taken by stakeholders to drive patient input into drug development, inspiring hope for those interested in progress toward novel therapies.