Expenditure on medicines dispensed through pharmacies open to the public amounts to €7,208.8 million (6.39% of the National Health Fund), whilst expenditure on medicines purchased directly by public healthcare facilities amounts to €13,605.9 million (12.06% of the National Health Fund).

This expenditure excludes expenditure on innovative medicines and on antibiotics for the treatment of infections caused by multi-resistant bacteria, which amounts to €654.9 million, as well as expenditure on medical gases (€212.6 million).

This is according to the ‘Monitoring of national and regional pharmaceutical expenditure, January–October 2025’ presented to the AIFA Board of Directors.

In total, pharmaceutical expenditure (direct purchases + under approved care regime) in the first 10 months of the year stood at €21.027 billion, with a deviation from the planned ceiling of €3.77 billion.

Compared with the monitoring of national and regional pharmaceutical expenditure for January–September 2025, the proportion of total expenditure (under the approved care regime, direct purchases and oxygen) has risen from 18.15% to 18.64%.

In particular, a comparison of expenditure on direct purchases, excluding medical gases, with the relevant 8.3% ceiling of the National Health Fund (FSN) shows a share of 12.06%, higher than that recorded in the same period of the previous year (11.33%), exceeding the ceiling by €4,243.9 million; however, the increase in expenditure observed in this channel between January-October 2025 and the same period in 2024 (+8.8%) is more modest than that recorded between January–October 2024 and the same period in 2023 (10.2%).

Furthermore, a comparison of expenditure under the approved care regime with the relevant 6.8% ceiling of the National Health Fund (FSN) shows a ratio of 6.39%, a figure higher than that recorded in the same period of the previous year (6.31%), exceeding the ceiling by €461.3 million.

However, the trend in expenditure under the approved care regime compared with the ceiling is influenced by the implementation – not yet complete as of October 2025 - of the effects of the reclassification of antidiabetics belonging to the gliflozin category from class A-PHT to class A (AIFA Decision No. 926/2025), which on the one hand will increase expenditure under the National Health Service and on the other will reduce expenditure on direct purchases.

With regard to regional differences, this Monitoring Report also highlights significant variation in expenditure on direct purchases, with the proportion of expenditure relative to the National Health Fund ranging from 15.04% in Sardinia to 10.10% and 10.03% in Lombardy and the Autonomous Province of Trento, respectively.

With regard to expenditure on medicines covered by the National Health Service, the report shows a 0.4% increase in the number of daily doses dispensed (equivalent to €75.5 million), corresponding to a rise in net expenditure covered by the NHS of €252.6 million (+3.7%), with significant differences between the Regions, eight of which exceeded the 6.80% ceiling and five of which remained well within the ceiling (<5.5%).

The trend in public pharmaceutical expenditure, determined by a variety of factors, including the introduction of biotechnological medicines and medicines for advanced therapies and demographic changes characterised by an ageing population, has shown a growth trend in Italy over the last twenty years in line with that observed in other advanced economies with public healthcare systems. In this context, expenditure on direct purchases of medicines, across all reimbursement categories, incurred by public healthcare facilities recorded an increase of +8.1% for the period January-October 2025 compared with 2024, compared with +9.4% for the same period in 2024 compared with 2023.

Published on: 30 April 2026