BACKGROUND: The world highest prescription drug expenses in the United States (US) prompted development of several drug value frameworks, including the Institute for Clinical Effectiveness Review (ICER) Value Framework (VF). ICER is an independent organisation evaluating value of health interventions in the US. ICER VF uses robust methodology, and based on cost-effectiveness estimates, allows determining value-based prices and discounts required to reach cost-effectiveness thresholds. Value framework-driven prices are not binding for US payers, but since drug prices are currently a hot political topic, the question is how ICER VF may impact drug pricing negotiations in the US. DISCUSSION: The US market is heterogeneous with multiple payers applying various policies for formulary listing. Generally, cost-effectiveness data are not widely used by commercial payers and are prohibited for public payers. Nevertheless, payers started scrutinising ICER VF to support their decision-making for expensive drugs. Last year, ICER announced collaboration with the Department of Veterans Affairs Pharmacy Benefits Management Services. ICER reports are also being incorporated into decisions by Medicaid and major pharmaceutical benefit managers. Some drug companies notice ICER’s increasing influence and start working with the Institute to evaluate drugs prior to launch. The use of ICER VF should expand further in the future. With a recent grant from the Laura and John Arnold Foundation, reviews for all new medicines and any price increases are expected. Moreover, the principle of value-based decision-making aligns with the strategy being considered by the Trump’s administration, intended to lower drug prices and reduce out-of-pocket costs. However, place of ICER VF in such value-based environment is currently unknown. CONCLUSIONS: Value-based pricing is increasingly scrutinised in the US and the ICER VF gains payers’ attention. Pharma companies should early anticipate ICER assessments, be ready to address health economic model requirements, and engage early in the drug assessment process.