OBJECTIVES:  To evaluate market access agreement (MAA) consequences on drugs purchasing in Paris Public Hospital (AP-HP). METHODS:  An observational retrospective study was conducted to analyze first drug admission in AP-HP hospitals between 2010-01-01 and 2015-03-31. Only drugs evaluated by the French economic comity for health products (CEPS) were qualified by 32 criteria clustered in 4 groups: general information, scientific evaluation by health authorities, main distribution network and commercial negotiations. Negotiations were qualified based on two dimensions: negotiation difficulty by AP-HP drug purchasing expert (I to IV difficulty level) and MAA nature obtained by a survey conducted through drug manufacturers. The potential correlation between negotiation difficulty and MAA nature was studied. RESULTS:  Of the 106 drugs admitted, 73 were included. The AP-HP expert survey described 18 medicines (25%) with a difficulty level of I (easily negotiated), 14 (19%) of II, 24 (33%) of III and 17 (23%) of IV (hardly negotiated). 57% of manufactures qualified information regarding MAA as confidential. Drug manufacturers (23% response rate) revealed that within the difficulty level I, seven MAA (2 drugs) were clearly identified, no information was available for other drugs. For difficulty level II, fifteen MAA (2 drugs) were well described and for 43% of drugs, we had no information regarding MAA. For difficulty level III and IV, six and two MAA (2 drugs each) were identified respectively, for 83% and 82% respectively we had no information. Price discounts obtained through negotiations were identified only in level I and II groups (66% and 100%), whereas discounts on reaching turnover goals were higher within the two hardly negotiation groups (50% and 33%). CONCLUSIONS: This study allowed us to evaluate drug price negotiation by hospital drug purchasing experts and MAA concluded by manufacturers. Confidentiality regarding MAA was important and did not allow us to identify clear correlation between these two aspects.