The Institute for Clinical and Economic Review, the nonprofit that prices drugs against the health gains they deliver, published a report on October 20 finding that the net launch prices of two-thirds of the new prescription drugs it reviewed between 2022 and 2025 far exceeded its cost-effectiveness thresholds. Adjusted for inflation, the median net price of new medicines spiked from $190,000 in 2022 to $257,000 in 2025, though most of that rise came early in the period, ICER said. The 2025 figure includes one-time gene and cell therapies, which are expensive to manufacture but typically administered once. Nearly a quarter of the drugs ICER evaluated in 2025 carried a net price above $500,000.
The report named the biggest disconnects. Insmed’s lung disease drug Brinsupri and Merck & Co.’s pulmonary arterial hypertension medicine Winrevair would each need discounts of around 90 percent from current costs to meet ICER’s guidelines. Johnson & Johnson and Legend Biotech’s CAR-T therapy for multiple myeloma, Carvykti, could be cut by one-third from its $465,000 net price to justify its cost, while Vertex and CRISPR Therapeutics’ gene editing treatment Casgevy might need only a 7 percent reduction from its $2.2 million price to represent good value. Vertex’s non-opioid pain drug Journavx was judged to be priced within the thresholds. ICER’s benchmarks are $100,000 or $150,000 per quality-adjusted life year, a framework similar to the one the United Kingdom’s National Institute for Clinical Excellence uses.
ICER paired the pricing with an access argument aimed at both sides. It called on drugmakers to adopt fair pricing, and pushed insurers to widen access, noting that four in 10 prescriptions for the medicines it reviewed were rejected and that the numbers were worse for Medicare recipients. “Value-based drug pricing should be met with streamlined access to new drugs with little to no cost-sharing for patients,” the group argued.
A separate analysis from STAT, published the same day, complicates the chart without contradicting it: that review found that launch list prices for new medicines dipped very slightly in 2025 but remained high. The measures differ, list versus net, and the samples differ, which is why one can dip while the other’s median net price stays elevated. The common fact is the level, not the slope. Drugmakers have long contended ICER’s methodology is flawed, but the framework is the closest the United States has to the value assessments that set prices abroad, and successive administrations have kept the political pressure on: the Biden Medicare negotiation law and the Trump most-favoured-nation deals have, as BioPharma Dive noted, yet to meaningfully affect pharmaceutical companies’ bottom lines.