2025 drug reimbursement trends report

Turquoise Health and ZS's 2025 drug reimbursement trends report analyzes millions of hospital and payer-reported drug rates to identify cross-therapeutic area trends.

Examining seventeen medical benefit products across four high-cost therapeutic areas, the report reveals the extent to which drug reimbursement is influenced by local payer–provider control and contracting dynamics.

Findings indicate that while many providers are reimbursed near Average Sales Price (ASP), hospitals — especially under commercial contracts — frequently secure rates 3–5× ASP, with outliers hitting 10× ASP for some biosimilars.

Our findings reveal:

• Payer-provider reimbursement is heavily influenced by provider-payer control dynamics across therapeutic areas
• Hospitals are ~3× more likely than specialty groups to secure premium rates above 200% of ASP, fueling large differences in the costs of products and services across sites of care
• Regional payers are more exposed to higher reimbursement rates than national payers, reflecting local providers' stronger bargaining power
• Reimbursement differences across products carry significant revenue implications for providers — as high as $100k per patient per year
• With price transparency, knowledge is power. These insights offer an early peek into a future where healthcare is more shoppable and transparency puts downward pressure on costs

The report highlights the reimbursement insights that can be extracted at the individual payer, provider, and product level through Transparency in Coverage (TiC) data.