ICER has put price and access in one dataset, and that is the argument it wants payers to use. Two in three reviewed drugs launched above their value benchmark, and the same drugs were blocked at the pharmacy counter, mostly by non-coverage rather than prior authorisation. Across payers, 39% of prescriptions were rejected for non-coverage, against 7% for prior authorisation or step therapy.

• Launch teams: the discount table is now public. The report lists 18 drugs priced above benchmark with the discount each would need, from about 95% for Brinsupri to under 10% for Lenmeldy and Casgevy at $100,000 per QALY. Payers will quote those figures in contracting, and the next brand on the list will face its number before launch.
• Medicare Part D plans: the access gap is widest in your channel. ICER asks payers to set coverage within 90 days of approval, and immediately for rapidly progressive or fatal conditions with no alternative. New-to-market blocks in Medicare are now the documented reason most first prescriptions fail.
• Signposts: the webinar, a coverage norm and the 2026 median. Watch ICER’s 27 October webinar, whether any large payer or CMS adopts a 90-day coverage standard, and whether 2026 launches hold the median above $250,000.