ICER Analysis Finds Net Prices of New Drugs Rose 51% Over Three Years

The median annual net price of drugs launched from 2022 to 2024 increased by 51%, according to a new analysis from the Institute for Clinical and Economic Review (ICER). Additionally, ICER researchers found that aligning the prices of therapies with the organization’s health benefit price benchmark could have saved the U.S. healthcare system between $1.3 billion and $1.5 billion in the first year after approval, according to the findings of the Launch Price and Access Report.

“The launch prices in terms of net prices continue to rise,” ICER’s Senior Vice President of Research Foluso Agboola, said in an interview. “We see the majority of the drugs are still priced way higher than what ICER suggests is a fair price, and we were able to estimate what the cost is as a society. We’re able to show what the excess drug spending looks like, which we could have used for other health services in the health system.”

ICER analyzed launch price trends over a three-year period, from 2022 to 2024. In total, 154 novel agents were approved by the FDA Center for Drug Evaluation and Research (CDER) and Center for Biologics Evaluation and Research (CBER).

The analysis showed a 24% increase in the inflation-adjusted median annual launch list price from 2022 to 2024. There was a larger 51% increase in the median annual net launch price (minus rebates, discounts, and other reductions) after adjusting for inflation. ICER adjusted the analysis for products with significantly higher prices, including gene and cell therapies, orphan products, and specific therapeutic areas, including oncology drugs and endocrine/metabolic drugs. After accounting for this, the list price increased by 25% per year, while the annual net launch price increased by 33% per year.

ICER used an algorithm to determine the best net price estimate, Agboola said. For physician-administered drugs, they prioritized average sales price. “But the limitation is there may be some 340B discounts that may be missing from that,” she said.

For nonphysician-administered drugs, they looked at different sources that report gross-to-net discounts to get to what the best net estimate would look like. “We reached out to the manufacturers and told them the net price we were going to be using for analysis, giving them a chance for them to correct that.”

ICER used its equal value life years (evLYs) lost assessment — health benefits lost because the excess drug spending was not directed to other high-value interventions or services — and assumed $100,000 spent is equivalent to an evLY lost.

Based on this assumption, researchers determined the discounts needed to be within ICER’s health benefit price benchmark. Some therapies would need significant price reductions to fall within that range.

For example, Merck’s Winrevair (sotatercept-csrk), which was approved in 2024 and is used to treat patients with pulmonary arterial hypertension, has an annual net price of $196,112 but would need a discount of between 81.9% and 90.9% to be considered within range. Another example is BridgeBio’s Attruby (acoramidis), which has a net price of $183,404 and would need a discount of between 78.7% and 92.6%. Attruby is approved to treat transthyretin amyloid cardiomyopathy, a type of heart failure.

Other therapies would require smaller reductions in price to meet the ICER standard for the health benefit they provide. For example, the gene therapy for sickle cell disease and transfusion-dependent beta thalassemia Casgevy (exagamglogene autotemcel) would need a discount of between 6.8% and 38.6%. The Alzheimer’s drug Leqembi (lecanemab-irmb) would need a discount of between 18.8% and 66.4%.

ICER also asked manufacturers for their own economic evaluation of the price. “Some of the companies gave us what they considered their price and justification,” Agboola said. “I think when companies do their own economic evaluation, some of the data around it and what they use and their assumptions are not transparent. So there isn’t an opportunity to be able to vet some of that.”

Agboola said that although ICER analysts may not have agreed with manufacturer assumptions, “there was some of the transparency that we are really asking for,” she said. “One of the things we try to show in this analysis is what the opportunity cost of not paying for value is. Many times, we’re not thinking about that. We’re not thinking about the excess drug; we're not thinking about the impact on rice and premiums.”

Impact on Patient Access

ICER also evaluated patient access barriers to newly launched drugs. Researchers focused on novel drugs approved in 2024 among a database of specialty coverage for 18 large U.S. commercial health plans. For the majority of these drugs, insurance coverage policies were not publicly available, even up to one year after approval. They found that for those with commercial insurance in the first quarter of 2025, about half of prescriptions were rejected.

They also conducted group discussions on patient access. “We had the opportunity to look at various data on patient access, but we knew that it wasn’t going to be rich enough without actually hearing from the patient,” Agboola said.

ICER reached out to patient advocacy organizations to better understand access challenges in their communities. They conducted focus groups separated by rare and non-rare conditions.

“There were challenges with insurance coverage, related to step therapy and prior authorization as we would expect,” Agboola said. “But there were also other noninsurance barriers to access, including the complexity in our healthcare system that makes it more difficult for patients, or the health inequity in our system.”

Officials from the National Pharmaceutical Council have criticized ICER’s analysis for ignoring actual market dynamics and failing to capture the full value medicines provide over their lifecycle to patients, health systems, and society.

“It’s disappointing that this new report is another ICER effort that does more harm than good due to a host of methodological, data, and analytic shortcomings,” Kimberly Westrich, NPC chief strategy officer, said in a statement. “The report has a biased and misleading ‘overspending’ analysis designed to create a headline: only ‘overspending’ due to drugs priced above ICER’s arbitrary benchmarks is included, while any ‘underspending’ is ignored.”