The AIFA analysis of the trend in pharmaceutical expenditure incurred by the NHS shows substantial stability in the last 3 years (on average 19.4 billion euros / year).

Citizens' private purchase expenditure (approximately 7.2 billion in 2020) continues to be a substantial part of pharmaceutical expenditure that needs to be monitored also for the purpose of assessing appropriateness.

The sustainability of expenditure, however, when compared to the expected funding levels (and specifically the expenditure relating to direct purchases), shows some critical issues: starting from 2017, in fact, in all Regions the pharmaceutical expenditure has overcome the governament funding with high variability among different Italian regions.

The additional Covid funds did not substantially change the overbudgeting levels of direct purchases. On the other hand, the additional quotas allocated to purchase by public pharmacies led to a greater surplus of unspent resources.

The new subdivision of the Fund, scheduled to start in 2021, will produce a rebalancing of resources between the two supply channels.