Medicines: NHS spending nears 25 billion; 2.3 billion from unregistered companies

The rise in pharmaceutical expenditure covered by the National Health Service is slowing, closing 2025 at just under 25 billion – compared with 23.659 billion in 2024 – with growth (+5.4%) falling below the 6–7 per cent mark, the rate seen in previous years. According to the latest report from AIFA, which officially finalises last year’s accounts, total expenditure – comprising contracted services, direct purchases and oxygen – actually reached 24 billion 937 million, accounting for 18.42 per cent of the Health Fund against a ceiling of 15.3 per cent (the resources available for pharmaceuticals in 2025).

It is striking, as has been the case for several years now, just how much hospital pharmaceutical expenditure has exceeded the budget: €4.7 billion, a trend which ‘consequently entails a budgetary adjustment of over €2.3 billion, compared with the approximately €2 billion recorded in 2024’: in practice, the repayment that pharmaceutical companies will have to make. They are already on edge over certain measures the Medicines Agency is currently working on to control expenditure: in particular, the revision of the formulary, which in recent weeks has been affecting various categories of medicines (such as sartans and statins), and the safeguard clause still under consideration. These are measures on which the Health Minister himself Orazio Schillaci is reportedly ready to seek clarification via two letters currently being sent out: one addressed to the Under-Secretary Marcello Gemmato (who is responsible for medicines) and the other to the leadership of AIFA, who have asked the minister for a sort of political endorsement of the measures under consideration. The battle over expenditure control is therefore still very much wide open, with the debate remaining intense.

Turning to the figures, in 2025 net public expenditure on medicines dispensed in local pharmacies (the state-contracted channel), will amount to 8,515.3 million euros, an increase of approximately 390 million euros (+4.8%) compared with 2024. However, this expenditure channel for the purposes of the spending cap (net expenditure + fixed prescription charge) stands at 8,744.8 million euros, which, against the 6.80% cap, results in a surplus of 459.3 million euros and an impact on the Health Fund of 6.46 per cent, a slight increase compared with the 6.31 per cent recorded in the previous year (+0.15 per cent). Expenditure on direct purchases of Class A and H medicines by public healthcare facilities, amounting to €17,220.5 million (gross of current paybacks), shows a 6% increase compared with 2024. This represents a change that is ‘significantly more modest than that observed in the 2023–2024 period (+10.5%)’, according to the monitoring report. As for expenditure on innovative medicines, compared with 2024, there has been a decrease of approximately 168 million, despite access to the fund having been extended from 1 January 2025 to include medicines with conditional innovation status as well; this is because ‘some medicines, which account for more than 400 million euros of pharmaceutical expenditure, no longer meet the innovation requirement’