The governance of pharmaceutical expenditure consists of a series of actions aimed at adjusting expenditure for medicinal products supplied by the National Health Service to the level of financial resources available. This is one of the objectives of AIFA, which is called upon to ensure the economic balance of the system by respecting the expenditure ceilings.

The governance of national pharmaceutical expenditure makes use of four main instruments:

• Ceilings for outpatient and inpatient NHS pharmaceutical expenditure;
• Monitoring of pharmaceutical expenditure;
• a predefined budget for each marketing authorisation holder;
• payback to the Regions after exceeding the pharmaceutical spending ceiling