The analysis of trend in pharmaceutical expenditure incurred by the NHS shows a considerable stability, particularly in recent years (2019 - 2021) corresponding to the pre and post pandemic period.

Citizens' private purchase pharmaceutical expenditure (approximately 7.7 billion in 2021) continues to be a substantial part of expenditure that needs to be monitored for appropriateness purpose.
In the three-year period December 2018 - December 2021 there is a gradual reduction in the distance between total expenditure and the allocation of financial resources.

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.

The remodeling of the pharmaceutical expenditure financial caps, since 2021, has produced an increase of efficiency by bringing the allocated resources closer to actual pharmaceutical expenditure.  In fact, on one hand, it led to a reduction of expenditure over-budgeting for direct purchases of over € 1 billion and on the other the surplus recorded for the approved care regime expenditure decreased, which however stood at values exceeding 500 million.