OBJECTIVES: Despite a regulatory delay in the requirement that US payers publicly post negotiated prices for prescription drugs, some payers have chosen to make this information available. The objective of this study was to assess the availability and utility of net pharmaceutical pricing data posted by commercial payers in response to the CMS Transparency in Coverage rule.

METHODS: Clarify Health has compiled and enriched payer price transparency data from the ten largest national commercial payers. By NDC, we categorized drugs into therapeutic categories and by average negotiated price. Summary statistics highlight both the availability of net pricing information as well as differences in pricing by therapeutic category and across payers. Categorization of net prices for pharmaceuticals by drug class highlights the high negotiated rates of recently introduced gene and other single and short-term (SST) therapies.

RESULTS: Two national payers have released prescription drug rates, including commercially negotiated rates for 199,384 and 56,759 unique NDC codes, respectively. Reflecting 471,365 and 468,901 distinct negotiated rates, respectively, net pricing for a prescription drug averaged $3,522 and $2,035 but was widely distributed (standard deviation $31,115 and $11,905). For both payers, the top ten highest priced drugs consisted of branded SST therapies. These ten therapies have average negotiated rates ranging from $53,619 to $2.48 million: lutetium lu 177 dotatate, ibritumomab tiuxetan, flutemetamol F-18, lumasiran, lisocabtagene maraleucel, idecabtagene vicleucel, ciltacabtagene autoleucel, tisagenlecleucel, voretigene neparvovec, onasemnogene abeparvovec. Negotiated rates for these therapies were consistently higher for one of the payers, with cross-payer differences ranging from $8,694 to $351,977.

CONCLUSIONS: Prescription drug prices negotiated between payers and manufacturers are not yet required for release under the Transparency in Coverage regulations, but are nonetheless beginning to appear in publicly released data. Increased reporting efforts have the potential to inform the industry regarding historically concealed negotiated rates for prescription drugs.