Medicine purchasing and pricing decisions usually rely on officially published prices. Literature has reported evaluations of publicly stated prices. However, due to the frequent use of confidential price arrangements there are indications for paucity of data on actual medicine prices. Therefore, the study aimed to systematically review literature with regard to availability of information on actual medicine prices. Areas covered: The Medline database was searched systematically to identify studies addressing actually paid prices of medicines used in-patient or out-patient care from the health care payer, health provider, or patient perspective, published during 2007–2017. A total of 33 observational studies were included in the analysis. Expert commentary: The review confirmed the paucity of studies on actual medicine prices, with only few studies evaluating differences between official and actually paid prices. The included studies are heterogeneous and differ in their design and focus. Non-availability of actual price data in several non-European countries results from lack of price regulation, which usually coincides with variation in actual prices for the same medicines between different dispensaries. In high-income, mostly European countries, transparency of actual prices is limited due to increased use of confidential medicine price arrangements.