2026 Southeastern Residency Conference

CLASS OF TRADE: AN EXPLORATORY REVIEW THROUGH THE LENS OF A NATIONAL GROUP PURCHASING ORGANIZATION
Benton Zielinski, Laura Crow, Samantha Randlett, Alyssa Huff, Jason Braithwaite
HealthTrust Performance Group/University of Tennessee Health Science Center – Nashville, TN
Background/Purpose: Class of Trade (COT) is a classification of types of healthcare facilities that pharmaceutical suppliers use to determine the price facilities pay for pharmaceutical products. For example, hospitals and retail pharmacies may be classified in different COTs and thus may pay different prices for the same product. No industry standard criteria exist for COT definitions or eligibility determination. Lack of standardization leads to inconsistent COT eligibility determination across pharmaceutical vendors. The purpose of this research was to clarify COT definitions and eligibility criteria as defined by pharmaceutical suppliers to empower healthcare facilities to optimize their pharmaceutical pricing via appropriate COT designation.

Methodology: This was an exploratory review, designed to assess how pharmaceutical suppliers determine COT eligibility. Eligible participants were pharmaceutical suppliers with active contracts with HealthTrust Performance Group (HPG). An anonymous survey was sent to 115 eligible suppliers. Respondents were asked to indicate their supplier type based on their predominant pharmaceutical products (Brands/Reference Biologics, Generics/Biosimilars, or Mixed), whether they use standard definitions for COT, whether an internal or external team determines facility eligibility, and which identifiers are used in this determination. Additionally, respondents were requested to provide their definitions for COTs. The primary endpoint was the frequency distribution of each COT based on total reports across responses. Secondary endpoints were percentage of COT criteria alignment to HPG standard definitions and the number of COTs indicated, both reported by supplier type.

Results: A response rate of 13.0% was achieved, with 15 respondents out of 115 invited to participate. Of these respondents, 8 (53.3%) indicated their supplier type as Brands/Reference Biologics, 5 (33.3%) as Generics/Biosimilars, and 1 (6.7%) as Mixed. The frequency distribution of each COT was reported as follows: 14 (93.3%) Acute Care Hospital; 12 (80.0%) Long Term Care; 11 (73.3%) Ambulatory Care (Hospital-Based); 10 (66.7%) Retail Pharmacy (Specialty); 9 (60.0%) Ambulatory Care (Community-Based); 9 (60.0%) Home Health Care; 9 (60.0%) Retail Pharmacy (Non-Specialty); and 10 (66.7%) use ≥1 additional COT not listed in the survey. Use of standard COT definitions was reported by 14 (93.3%) respondents, with 10 (66.7%) determining COT eligibility internally, 1 (6.7%) externally, and 4 (26.7%) both internally and externally. Average COT criteria alignment between respondents’ definitions and HealthTrust standard definitions were 68.0% for Brands/Reference Biologics, 45.1% for Generics/Biosimilars, and 87.5% for Mixed. The average and range of number of COTs indicated were 9.56 (0-37) for Brands/Reference Biologics, 17.4 (6-31) for Generics/Biosimilars, and 8 (8-8) for Mixed.

Conclusions: Although sample size was limited, this exploratory review identified considerable heterogeneity in COT definitions and facility eligibility criteria across pharmaceutical suppliers, with lower alignment observed among Generics/Biosimilars compared with Brands/Reference Biologics. The lack of standardized, public COT definitions prevents healthcare facilities from optimizing pricing and access to pharmaceutical products, ultimately impacting patient care by constraining financial sustainability.