The analysis of the trend of pharmaceutical expenditure incurred by the NHS shows an increasing trend in 2022, after a period of substantial stability, which had been observed particularly in the last years (2019 - 2021) corresponding to the pre- and post-pandemic period.

Citizens' private purchase pharmaceutical expenditure (approximately 8.4 billion in 2022) continues to be a substantial part of expenditure that needs to be monitored for appropriateness purpose.

Compared to the three-year period December 2018 - December 2021, in 2022 the gap between overall spending and allocation of financial resources seems to increase

The sustainability of expenditure, however, when compared to the expected funding levels (specifically for the expenditure related to direct purchases), highlights differences among Italian regions: if, in fact, in a group of regions (Piedmont, Lombardy, Veneto , Emilia Romagna and Tuscany), representing more than 45% of the total assisted population by NHS, the financial resources cover almost all pharmaceutical expenditure, in other regions, despite the 'compensation' effect between the two expenditure components (care regime and direct purchases) much higher levels of expenditure are observed in comparison to available resources.