CareCost Data
Insurance pricing data, with the coverage rules attached
Rate vendors sell you what an insurer pays. Policy vendors sell you what it demands first. We sell both, from the insurers’ own federal filings — priced on the page, with every column published before you buy.
Five datasets. Prices and full column lists published. No demo required to find out what is in it.
36.8M
negotiated rates
as of 2026-Q2-06
37
insurers
as of 2026-Q2-06
50 + DC
states
as of 2026-Q2-06
353,270
billing codes
as of 2026-Q2-06
Quarterly
updated
as of 2026-Q2-06
No patient dataNo BAA neededBuilt from public federal filingsFull schema published
Five datasets
Built from one body of data, sold separately because most teams need one of them. Each lists its price, what is in it, and what it will not do.
What each insurer pays for every specialty and infusion drug, and for administering it.
- CoversSpecialty and infusion drug codes, plus the administration codes
- Insurers37 insurers, 50 states and DC
- Compared toMedicare, ASP+6% and drug acquisition cost
- UpdatedEvery quarter
Questions it answers
- What does this insurer pay for zoledronic acid in Texas, and how does that compare with Medicare?
- Which of our top ten drugs are paid below the federal benchmark, and in which states?
$16,000a year · slices from $6,000
The same rates across all 350,000+ billing codes, not just drugs.
- CoversAll 350,000+ billing codes
- Insurers37 insurers, 50 states and DC
- Compared toMedicare and, for drugs, ASP+6%
- UpdatedEvery quarter
Questions it answers
- What does each insurer pay for a knee replacement in our metro area?
- Where does our current fee schedule sit against the market, line by line?
$60,000a year for everything · slices from $8,000
Every hurdle an insurer puts between a prescription and a payment — prior authorization, step therapy, site limits, renewals.
- Size2,423 drug-and-insurer pairs — 104 drugs across 30 insurers
- Built from2,634 insurer policy documents, read and quoted
- CoversPrior authorization, step therapy, site of care, renewals
- Depth81% of pairs require prior authorization
Questions it answers
- Which insurers require two other drugs to fail before ours, and which two?
- What did this insurer’s policy actually say in March, when the claim was denied?
$150,000a year for everything · slices from $6,000
Rates and coverage rules in the same row. No other published dataset has both.
- CombinesNegotiated rates and coverage rules in one row
- Gives youA friction score and a flag for underpaid, hard-to-get drugs
- TraceableEvery row links back to the exact quoted rule
- AvailableNowhere else — no other published dataset has both halves
Questions it answers
- Rank every insurer by what they pay for our drug and how hard they make it to get.
- Where is our drug both underpaid and sitting behind a competitor in step therapy?
$210,000a year for everything · slices from $20,000
What one named practice is contracted for, with which insurers, at what rates — down to the plan.
- Identity18.6M tax-ID-to-provider links across 890,761 resolved practices
- Names1.47M alternate and legal names, so one practice is one row
- Insurers acceptedWhich insurers each practice holds a contract with, per provider
- Grounded byMedicare volume, so a dead contract line is visible
Questions it answers
- We are buying this infusion group. What are its contracted rates, and how do they compare with the market?
- Which practices in this metro have the strongest commercial contracts for our drug?
$80,000a year for everything · slices from $10,000
How this compares with what you have now
Most teams working on payer strategy already have part of this. Here is what each of the usual routes gives you, and where it stops.
Building it from the public files yourself
- What it gives you
- Total control, and the files are free.
- Where it stops
- Tens of terabytes of nested files per quarter, different units per insurer, provider references that resolve to nothing, and formats that change without notice. The build is not the hard part — the quarterly rebuild is.
- What we add
- The pipeline, already running, with the units converted and the providers matched.
Buying raw machine-readable files from a reseller
- What it gives you
- The same public files, in a tidier container.
- Where it stops
- Still per-vial against per-milligram, still no benchmark to read a number against, still no idea how many providers sit behind a rate.
- What we add
- Common units, Medicare and ASP+6% alongside every rate, ranges instead of single numbers, and a quality score on each row.
A formulary and payer policy vendor
- What it gives you
- Coverage rules, restrictions and formulary position — the established answer for market access teams.
- Where it stops
- No negotiated rates. You can see that a drug needs prior authorization and two failed alternatives, but not what the insurer pays for it when it is finally approved.
- What we add
- The rates, in the same row as the rules, so access difficulty and economics can be read together.
A rate benchmarking platform
- What it gives you
- Negotiated rates, usually in a dashboard, usually aimed at hospital contract negotiation.
- Where it stops
- No coverage rules, and normally no drug-level depth — administration codes and acquisition cost are rarely included.
- What we add
- Drug-level depth including the administration codes, plus the coverage requirements the rates sit behind.
How to buy
From $16,000 a year
License a dataset
Tell us which dataset and how much of it you need — one insurer or all of them, one state or the country. We come back within one business day with a price and a start date.
Get access
Free
Look at it first
A real slice of the file: three states, every column, actual rows. Load it against your own model before you talk to anyone.
Download the free sample
$2,500–$7,500
Just get one answer
You have one question and a deadline. We run it against your drugs and your markets in about three business days and send back the answer, the charts and the rows underneath.
Ask a question
Where the data comes from
Federal rules require insurers to publish the rates they have agreed to pay, and to publish their coverage policies on their provider sites. Those filings are public and they are the only source of rate and rule data here. We add CMS reference data — the Medicare fee schedules, average sales price, drug acquisition cost and the national provider registry — to make the numbers comparable.
There is no patient data in any of it. No claims, no medical records, no enrolment files. Nothing that needs a business associate agreement, because nothing protected ever enters the pipeline. How we source and license the data.
If you want to see what we do with this data ourselves, the Infusion Reimbursement Index is published free every quarter.
Who builds this
CareCost is built and run by Erin Rose. The methodology, the numbers ledger and every correction on this site are hers.
CareCost Data is at design-partner stage. We would rather tell you that than imply a customer list we do not have.
Get access
Tell us which dataset and how much of it you need. We come back within one business day with a price and a start date.