Italian public pharmaceutical expenditure reached €4.530 billion in January–February 2026, equivalent to 19.31% of the provisional National Health Fund. The main budget pressure remained in direct purchases – medicines bought by hospitals and other public healthcare structures for use within those services or direct supply to patients, rather than reimbursed through the conventional community-pharmacy channel.
The Italian Medicines Agency (Agenzia Italiana del Farmaco, AIFA) reports direct-purchase expenditure, including medical gases, of €3.011 billion. Excluding the separately financed categories used for ceiling assessment, expenditure exceeded the 8.60% statutory allocation by €950.6 million. Community-pharmacy expenditure remained €88.7 million below its 6.85% ceiling.
The early-2026 direct-purchase deficit is slightly below the €1.025 billion recorded in January–February 2025, despite expenditure remaining high. The comparison also reflects an increase in the main direct-purchase ceiling from 8.30% to 8.60%.
AIFA's final 2025 calculations subsequently put the full-year direct-purchase overspend at €4.767 billion, generating €2.385 billion of company payback. For early 2026, AIFA estimates that seasonal purchasing patterns reduce the underlying direct-purchase incidence to about 12.00% of the health fund, still well above the 8.60% ceiling.
Applying the seasonally adjusted 12.00% rate to the current funding base would imply an annual overspend of roughly €4.8 billion. Under the current 50% payback mechanism, that would again produce liabilities of around €2.4 billion, leaving expenditure pressure broadly at the 2025 level despite the higher ceiling.
Source: Italian Medicines Agency
Link: Spesa farmaceutica gennaio-febbraio 2026: monitoraggio AIFA definitivo (Pharmaceutical expenditure January–February 2026: final AIFA monitoring)
Date: 25 September 2026
Source: Italian Medicines Agency
Link: Ripiano della spesa farmaceutica per acquisti diretti per l’anno 2025 - Avvio del procedimento - Pubblicazione dei dati (Payback of pharmaceutical expenditure for direct purchases for 2025 – start of procedure – publication of data)
Date: 30 July 2026
Source: Italian Medicines Agency
Link: Monitoraggio AIFA della spesa farmaceutica gennaio-dicembre 2025 (AIFA monitoring of pharmaceutical expenditure January–December 2025)
Date: 17 June 2026
