The launch of high priced drugs in recent years has led to the perception of an unsustainable fiscal environment in the US healthcare system. Stakeholders have highlighted the need for a third party, HTA like organization to implement value based frameworks in order to deal with this problem. With ICER’s rise to prominence over the last few years, there has been a marked increase in discussions around how to evaluate the prices of new therapeutics from this lens. In this paper, ICER’s influence over the payer and manufacturer spheres is evaluated through primary research with these two groups of stakeholders. A secondary budget impact analysis is also conducted in order to estimate the potential savings to the US healthcare system if ICER’s cost effective prices were implemented across a selection of therapeutic areas.