The Inflation Reduction Act allows Medicare to negotiate prices on a limited set of drugs that are not necessarily the highest priced or lowest value. Across payers, interest in lowering drug spending remains high. The National Academy of Medicine recommends basing drug prices on value, tying prices to the magnitude of benefit to preserve incentives for innovation.2 One way to do this is to set prices to achieve a certain cost-effectiveness threshold. Value-based prices (VBPs) are estimated by the Institute for Clinical and Economic Review (ICER), an independent nonprofit that reviews all available evidence of a drug’s clinical effectiveness vs its economic cost to estimate its value. Reports of ICER reviews are increasingly used by US payers in drug price negotiations. The objective of this study was to estimate how annual US drug spending would change if prices for drugs were set to the ICER reported VBP.