A U.S. cost-effectiveness review criticized AstraZeneca’s newly approved hypertension drug Baxfendy on price relative to benefit. In a draft assessment, the Institute for Clinical and Economic Review (ICER) concluded Baxfendy did not meet commonly used cost-effectiveness thresholds at an assumed wholesale acquisition cost of $900 for 30 tablets. ICER also used a placeholder price to evaluate Mineralys Therapeutics’ investigational aldosterone synthase inhibitor lorundrostat, reaching the same conclusion that it was too expensive on the analysis framework. The review noted uncertainty around long-term effects and suggested questions remain, particularly for subgroups such as patients with chronic kidney disease. While ICER’s output is not an FDA decision, the findings can shape payer negotiations and formulary access—especially for first-in-class drugs entering crowded hypertension treatment algorithms.