Payers' experiences with confidential pharmaceutical price discounts: A survey of public and statutory health systems in North America, Europe, and Australasia.

•Confidential discounts are now common and often significant among in many countries.•Discounts range widely but are most commonly over 20% of list prices.•Confidential price discounts were more common, complex, and significant for specialty pharmaceuticals.•Views of discounts reflected tensions between local system goals and global impacts.