The application of a conventional cost-effectiveness analysis (C-CEA) for the value-based pricing of new medicines has largely ignored the implications of a fixed patent life or data exclusivity period. We believe that this creates several anomalies: 1) C-CEA will produce a different result than an actual CEA that considers generic or biosimilar entry; 2) the pricing of long-term treatments for chronic conditions and “repeated-dose cures” in a free and flexible pricing environment is likely to result in predictable price increases at the end of the exclusivity period that will upset patients and the public; and 3) “one-time administration cures” have the potential to capture a greater share of the consumer surplus over the product lifetime, which may be efficient per se, but also may inadvertently disadvantage the development of valuable long-term therapies for chronic conditions or repeated-dose cures. Emergence of the Institute for Clinical and Economic Review, which is arguably a form of “privately supplied regulation” of US drug prices and relies on C-CEA, may be producing inadvertent anomalies that distort prices and research and development (R&D) incentives. A demand exists for long-term solutions to these issues that would promote dynamically efficient global R&D. More work is needed on 1) the relationship between surplus reward and the amount and composition of global R&D, because we may be as likely to be encouraging excessive R&D in some areas and undersupplying it in others, and 2) the size of the surplus reward to R&D cost and to return on investment.