Price transparency has taken the healthcare industry by storm. Four years into a price transparent-healthcare, we have a wealth of data available…and a slurry of frequently asked questions regarding the data itself. Especially when it comes to drug price transparency data, what data is available and how can it be used? Is it just drugs or devices too? How long do I have to wait to swim after viewing the data? There’s much to discuss.
Here are the answers.
If only life were this simple.
If price transparency data is publicly available data, why can’t I download it myself?
Well, you could, you just probably don’t want to. Price transparency data is data mandated by a slew of regulations to be published via machine-readable file (MRF) to a hospital and payer’s website. Pay special attention to the term there, “machine-readable.” Meaning, opening a file will result in a slew of code—not readily digestible information.
This is the intention of these specific regulations, this data is not meant to be readily digestible information for consumers. (For more information on what data is meant to be readily available for consumers, see the No Surprise’s Act’s Good Faith Estimates and Advanced Estimate of Benefits).
At Turquoise, we download these files ourselves and conduct some significant engineering wizardry to turn the data from raw data to cleaned, enriched data you can make sense of.
What’s included in drugs data?
Thanks to recently effective regulations, there was an abundance of newly added drugs data. The Drug Reporting Requirement, effective 1/1/25, mandates hospitals to publish a machine-readable file (MRF) containing detailed drug information. That means we have Part B data now posted from hospital files. Coupled with the data available since 2022 thanks to Transparency in Coverage (TiC) and now the additions to the Hospital Price Transparency Rule, over 700 buy-and-bill drugs are included in the drugs data for all settings of care.
At the time of writing, we’re a little into the first fifteen days of The Drug Reporting Requirement going into effect. Many hospitals have been posting standardized unit type and measurement rates after the new 1/1/25 hospital MRF requirements went into effect. In the last two weeks, Turquoise has processed 1,300 updated hospital MRFs. Of those, about 70% of them have had standardized unit type/measurement for Part B.
At Turquoise, we’ve amassed the largest database of Commercial insurance rates across every setting of care including hospitals, provider groups, ASCs, laboratories, and DME. In addition to Commercial insurance rates, we also have Medicare Advantage and Managed Medicaid plans from the hospital files. Using Turquoise data, payers, providers, and drug manufacturers can drill down on a specific drug and its payer and provider contracted rate to preemptively determine if a provider account is above water or at risk of having a negative net cost recovery.
Does the data include pharmacy benefit data?
Not yet. The Part D rates were originally supposed to be posted in the original payer MRFs, but this was delayed indefinitely for over two years. CMS, in their most recent FAQs, hinted that this delay could be coming to an end soon. However, given the new administration taking office, we expect to see PBMs take center stage in the near future.
Is the data dose standardized?
Yes, Payer data has always been required to be dose standardized based on Transparency in Coverage. Thanks to the regulations now in effect as of 2025, hospitals must now include the drug unit and drug type measurement that corresponds to the established standard charge for the drug as well.
How often is this data refreshed?
Payers are required to update their files monthly, while hospitals are required to update their files at least once each year. As a result, we refresh our data monthly from payer files and any hospitals that updated their files.
That’s all for now, folks. If you have more questions or just want to wax poetic on data, send us