# An international registry of real (net) cancer drug prices paid by public payers

Source: https://onco.cc/ideas/idea-reg-net-price-transparency-registry/  
OnCo record `idea-reg-net-price-transparency-registry` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Countries negotiate secret discounts, so nobody knows what anyone actually pays for a cancer drug. Sharing real prices between public buyers would strengthen every negotiation.

## Summary

Confidential rebates mean list prices are fiction and payers negotiate blind, a situation that the WHO Fair Pricing Forum and the Oslo Medicines Initiative have identified as one of the main drivers of high prices. The proposal is a treaty-level or coalition arrangement in which public payers deposit net prices per oncology product into a secure registry visible to other participating payers (not to the public or industry), with aggregate transparency published annually. Beneluxa and the Nordic Pharmaceutical Forum already share some information.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Payers with access to the registry achieve net prices at least 10% lower than non-participants for the same products within three years, and the dispersion of net prices across similar-income countries narrows.
- Rationale: Information asymmetry favours the seller in every negotiation; shared price intelligence is standard practice among large purchasers in other sectors and is the cheapest lever payers have.
- Proposed test: Establish the registry among five to ten European payers for oncology products, and compare their net price trajectories with matched non-participating payers using confidential data audited by a neutral party.
- Maturity: speculative
- Actor: payer

## Sources

- Bottleneck evidence (Prices and value): Prasad, De Jesús & Mailankody, The high price of anticancer drugs: origins, implications, barriers, solutions (Nat Rev Clin Oncol 2017): https://doi.org/10.1038/nrclinonc.2017.31

## Connected records

- bottlenecks: [Data silos](https://onco.cc/bottlenecks/b-data-silos/), [Prices and value](https://onco.cc/bottlenecks/b-drug-pricing/)
- key papers: [The high price of anticancer drugs: origins, implications, barriers, solutions](https://onco.cc/key-papers/paper-prasad-nat-rev-clin-oncol/)

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