Data Gaps Undermine Use of Hospital Price Transparency Files for Drug Cost Analysis

A new analysis reveals that current Hospital Price Transparency (HPT) data are inadequate for evaluating reimbursement rates for provider-administered drugs, primarily due to missing information and inconsistent reporting of drug quantities.

Researchers analyzed over 3.3 million entries across 30 procedure codes for provider-administered drugs. Of these, 65% were missing key elements such as National Provider Identifier (NPI), reimbursement rate, or National Drug Code (NDC). Even among records with NDCs, pricing data were inconsistently reported in at least 3 different units: the unit of the procedure code, the unit of the NDC, or the total quantity administered to the patient.

These discrepancies introduce significant ambiguity into the data. As the authors noted, “Until providers follow standardized requirements for the reporting of the data, the Hospital Price Transparency data should be used with caution.”

For example, analysis of infliximab (100 mg vial) showed pricing data clustered around values that are likely to reflect different units. Some entries appear to be per 10 mg, matching the procedure code, others per 100 mg based on the NDC, and some for the full administered dose. This variation makes it impossible to reliably interpret price differences or markup estimates.

In January 2025, the new Centers for Medicare & Medicaid Services (CMS) rules will require hospitals to report the unit and type of measurement for drug charges. However, the authors warn that provider compliance remains a critical concern. “Compliance is concerning because, at the start of 2024, after 3 years of the Hospital Provider Transparency rule being in effect, 17% of providers still have not made their negotiated rates public.”

The study recommends that CMS strengthen enforcement and standardize data formatting to enhance usability. Without these changes, pricing transparency data will continue to fall short in enabling accurate assessment of drug reimbursement across providers.

Reference 
Pathak Y, Frid EM, Gabriel N, Tang S, Hernandez I. Limited utility of price transparency data for drugs. J Manag Care Spec Pharm. 2025;31(4). doi:10.18553/jmcp.2025.31.4.338