OBJECTIVES Cost-effectiveness analyses (CEA) are used to support funding decisions for new drugs by estimating their clinical and economic value. While prices of drugs may fall over time due to market competition, entrance of generic drugs, or negotiated price cuts, this is rarely accounted for in CEA. The objective is to review pharmacoeconomic guidelines and current practice around drug price evaluation in CEA. METHODS Pharmacoeconomic guidelines were reviewed to identify countries in which a drug price modification over the time horizon is allowed or recommended in CEA. Then methodological articles and published CEA using price modifications were identified. Finally, several health economics experts were interviewed. RESULTS Only 3 pharmacoeconomic guidelines report recommendations around price adjustment in CEA (Norway, New-Zealand): modellers should take into account changes in drug price over time. In France, it is possible to include a generic price in sensitivity analysis. In other countries, this was not mentioned in the guidelines. Methodological articles mentioned the possibility to use an estimated 4% decrease over time in UK. In most of published CEA incorporating price modifications, this was performed as secondary analyses. Other CEA reported dynamic incremental cost-effectiveness ratio (ICER), at the time of market entry and by year thereafter. While experts were not aware of any existing guidelines, the predominant view was that although using the brand price for the studied drug would be a conservative approach, it is reasonable to account for price reductions after patent expiration for all drugs considered. CONCLUSIONS Drug price variations may introduce a source of uncertainty in CEA, as both timing of entry and level of generic drug pricing are unknown. There is currently no consensus on how this should be considered. Failure to incorporate generic drug entry in CEA is likely to yield overestimates of ICER for treatments used over long-term.