OBJECTIVES: The Institute for Clinical and Economic Review (ICER) recently initiated a drug assessment program that entails a comprehensive health technology appraisal and economic evaluation made publicly available near the time of US approval. Thus far, five drug assessments have been completed, with public comments available on three. We analyzed written public comments to ICER on these three reports: sacubitril/valsartan (heart failure;HF), PCSK9 inhibitors (hypercholesterolemia), and new Hepatitis C drugs (simeprevir, sofosbuvir) to understand which stakeholders are engaging and what issues were raised. METHODS: Each correspondence to ICER was reviewed by a two-person team to identify comments specifically pertaining to the report or analysis, with data extracted on stakeholder type (manufacturer, provider, patient/advocacy group, plan, government, other) and comment type (modeling methodology, additional available data, personal experience, general support or criticism). Methodology comments were further categorized based on what aspects of the model were addressed. Finally, we explored the relationship between stakeholder and comment type using chi-square testing. RESULTS: CONCLUSIONS: ICER is the first major non-profit US group to engage stakeholders in a public discourse about drug effectiveness and affordability. Our analysis does not reveal the validity of stakeholder comments but suggests that manufacturers, providers, patients, government and plans are actively responding to the reports, particularly about modeling methods and additional available data.