Italy’s Medicine Spending Reaches €39.3 Billion in 2025 | iPharmaCenter

Italy’s pharmaceutical market recorded higher spending in 2025 despite a modest decline in the number of medicine packs dispensed, according to the latest OsMed report from the Italian Medicines Agency.

Total pharmaceutical expenditure reached €39.3 billion, representing a 6% increase from 2024. Public funding accounted for €28.4 billion, up 5.8% year over year, and represented 72.2% of total medicine spending and approximately one-fifth of overall public healthcare expenditure.

The report examines medicine use across Italy, including National Health Service distribution, purchases by public healthcare institutions, private spending, therapeutic categories, regional patterns, pediatric treatment, medicines for older adults, biosimilars, orphan medicines, and advanced therapies.

Medicine Use and Distribution

Under subsidized healthcare, citizens consumed an average of around 18 medicine packs during 2025. Daily dispensing reached 1,148.2 doses per 1,000 inhabitants, a 1% increase compared with the previous year.

When public and private community healthcare channels are combined, approximately 1.9 billion medicine packs were supplied during the year. This represented a 0.5% decrease from 2024.

Around 66.9% of people covered by the healthcare system received at least one medicine prescription during 2025. Medicine use and expenditure continued to rise with age, with individuals aged over 64 accounting for more than 60% of spending and nearly 70% of total doses.

Prescription prevalence varied across the country. The rate was 63.5% in northern regions, compared with 68.9% in central Italy and 70.4% in the south and islands.

Public and Private Spending

Purchases made by public healthcare institutions generated €18.9 billion in pharmaceutical expenditure, an increase of 6.2% from 2024. This category includes medicines acquired by hospitals, local health authorities, residential care facilities, correctional institutions, and public distribution services.

Public territorial expenditure reached €14.3 billion, rising 3.5% year over year. This figure includes Class A medicines supplied through contracted community healthcare arrangements, as well as direct and account-based distribution.

Private spending by citizens totaled €10.7 billion, up 7.5% compared with 2024. Growth was supported by several categories:

• Privately purchased Class A medicines increased by 16.2%.

• Class C prescription medicines rose by 7.4%.

• Nonprescription medicines grew by 6.5%.

  
  

Tirzepatide became the leading Class A medicine purchased privately by Italian citizens. Spending on the medicine reached approximately €225 million, equivalent to 13% of private Class A expenditure. Cholecalciferol, pantoprazole, and ibuprofen followed, with each recording higher spending than in 2024 as use increased.

Citizens also paid €1.04 billion in co-payments for the additional cost of choosing off-patent branded medicines over the applicable reference price. The average burden was €17.71 per person.

The highest per capita co-payment levels were recorded in Calabria, Sicily, and Campania, where citizens paid €22.35 on average. This compares with €13.73 per person in northern Italy and suggests that the switch from branded medicines to generics remains uneven across regions.

Leading Therapeutic Categories

Cardiovascular medicines remained the largest therapeutic category in public healthcare during 2025. The group generated average spending of €54.30 per person and recorded consumption of 508.93 defined daily doses.

The strongest increases in consumption occurred in the following areas:

• Genitourinary medicines and sex hormones, up 4.2%.

• Gastrointestinal and metabolic medicines, up 2.7%.

• Central nervous system medicines, up 2.1%.

Use of systemic anti-infective medicines declined by 7.9% in defined daily doses. Proton pump inhibitors remained the highest-spending category on a per capita basis at €9.65, although expenditure fell by 7.7% from 2024.

Tirzepatide had the highest average cost per daily dose at €25.23. Ceftriaxone followed at €11.23, while teriparatide ranked third at €10.31.

Public procurement spending was concentrated in antineoplastic and immunomodulatory medicines, which generated €144.36 per person. Medicines affecting the blood and blood-forming organs recorded the highest consumption in this channel at 54.87 defined daily doses.

Consumption rose for antineoplastic and immunomodulatory medicines, respiratory medicines, and systemic anti-infectives. The increases were 8.1%, 6.1%, and 2.4%, respectively.

By contrast, consumption fell for gastrointestinal and metabolic medicines by 11.5%, central nervous system medicines by 6.4%, and medicines affecting the blood and blood-forming organs by 1.1%.

PD-1 and PD-L1 inhibitors had the largest impact on spending among specific treatment groups, with per capita expenditure of €19.14. Interleukin inhibitors followed at €14.25 per person. Spending in these two categories increased by 9.1% and 2.8%, respectively.

Pembrolizumab generated €554.1 million in direct procurement spending, while daratumumab accounted for €553.5 million. Together, the two medicines represented 5.8% of total direct purchases.

Semaglutide ranked third at €335.4 million, followed by dupilumab at €312.4 million.

Pediatric and Older Adult Use

Approximately 4.1 million children, representing 46.3% of Italy’s pediatric population, received at least one medicine during 2025.

Systemic anti-infective medicines remained the most frequently used category among children, but consumption declined by 21.9%. Respiratory medicines ranked next and also recorded a decrease. Central nervous system medicines moved higher, with increased use of antiepileptic and psychotropic treatments.

Among people younger than 18, psychotropic medicine use reached 0.64% in 2025. This equates to approximately 6.4 children per 1,000 and represents a 12.1% increase over the previous year. The rate has more than tripled since 2016.

The largest increases involved methylphenidate, used in attention deficit hyperactivity disorder treatment, which rose by 28.9%. Aripiprazole increased by 14.6%, risperidone by 13.3%, and sertraline by 9.6%.

Respiratory medicine use among children stood at 17.8%, nearly twice the estimated asthma prevalence of 9%. The difference may point to prescribing for acute respiratory infections in children without asthma and reinforces the need for further education among primary care pediatricians.

Medicine use was particularly high among older adults. In 2025, 97.2% of people aged over 65 received at least one prescription.

Simultaneous use of five or more medicines affected 67.7% of older adults, while 27.9% used at least 10 medicines. Chronic polypharmacy, defined as taking five or more different medicines for at least six months during the year, affected 33.2% of this population.

Basilicata, Campania, and Puglia reported both higher consumption and greater average daily treatment costs than the national average. Average spending per medicine user aged over 65 reached €591.10. The figure was €648.23 for men and €545.72 for women, marking a 3.7% increase from 2024.

Diabetes and Weight Management

Spending on antidiabetic medicines totaled €1.59 billion in 2025, an increase of 34.9%.

Semaglutide and tirzepatide recorded particularly strong growth.

Private consumption of these medicines in Category C increased by 85.7%, while spending rose by 75.8%. The figures reflect rising demand for treatments used in diabetes care and weight management.

The Italian Medicines Agency is monitoring the development of this market as demand expands beyond traditional diabetes treatment.

Semaglutide generated €430 million in National Health Service expenditure and €162.7 million in Class C private spending. Tirzepatide accounted for €225.5 million in private Class A spending and €123.4 million in National Health Service expenditure under the conditions established by Note 100.

Antibiotics, Generics, and Biosimilars

Use of systemic antibacterial medicines through public healthcare declined by 7.9% in defined daily doses. Spending through this channel fell by 8.6%.

Public facility purchases followed a different pattern, with expenditure on systemic anti-infectives increasing by 2.4%.

Off-patent medicines represented 72.9% of spending and 88.1% of consumption under Class A healthcare arrangements. Generic medicines without patent protection accounted for 23.5% of spending and 32.1% of consumption.

Italy remained a European leader in biosimilar use, which represented 71.4% of consumption. However, generic medicine uptake was lower, particularly in southern regions.

Patients in the south and islands paid €22.35 per person, or €432.7 million in total, to select branded medicines instead of lower-priced alternatives. The comparable figures were €19.43 per person and €230.6 million in central Italy, and €13.73 per person and €380.4 million in northern Italy.

Italy Spending on Innovative and Advanced Therapies

Spending on innovative indications supported by the dedicated fund fell by 19.4% during 2025 to €700 million. Their contribution to total direct procurement by public institutions declined from 6.6% in 2023 to 4% in 2025.

The reduction was linked partly to several oncology and hematology medicines completing their three-year innovation period between 2023 and 2025. The introduction of new medicines with conditional innovation status also contributed to the lower financial impact.

A total of 1,195 advanced therapy treatments were administered during the year, generating €222.6 million in expenditure. This included 784 CAR T treatments costing €149.3 million and 411 non-CAR T gene and tissue therapies costing €73.3 million.

Two advanced therapies entered the Italian market for the first time in 2025. These were tabelecleucel for Epstein-Barr virus positive post-transplant lymphoproliferative disorder and etranacogene dezaparvovec for hemophilia B.

Orphan medicine spending increased by 7.9% to €2.55 billion. These products accounted for 8.6% of National Health Service pharmaceutical expenditure.

Antineoplastic and immunomodulatory medicines represented the largest share of orphan medicine spending and consumption, accounting for 46.5% and 47.7%, respectively. Medicines for genetic disorders, lymphoma, myeloma, and other blood cancers made up the largest therapeutic group, with genetic disease treatments accounting for 32% of spending and hematology and oncology treatments representing 31.6%.

European Position

Italy’s combined public and private pharmaceutical expenditure, including community and hospital channels, reached €750 per person in 2025.

This was below Germany at €779 and Austria at €795. Italy’s figure was higher than Belgium at €738 and Spain at €727. It also exceeded spending levels reported for Poland at €388, Sweden at €536, Portugal at €541, and the United Kingdom at €575.

Average community pharmacy prices were higher in all nine comparison countries than in Italy. Germany recorded community prices approximately 372.4% above Italian levels.

Italy continued to record a relatively low share of pharmaceutical spending on generic medicines compared with other European markets. The country ranked first among the 10 countries studied for biosimilar use, accounting for 70.3% of spending and 71.4% of consumption. The corresponding averages across the comparison group were 60.9% for spending and 45.9% for consumption.

Italy ranked fourth for orphan medicine spending per person at €52.90. France led at €77.90, followed by Austria at €74 and Belgium at €73.

Expanded Data Analysis

The 2025 OsMed report introduced several new analytical elements, including detailed coverage of medicines for pediatric respiratory conditions, newer high-use therapeutic groups, and regional differences in medicine consumption.

For the first time, the report used sell-out information to examine private purchases of Class A medicines between 2023 and 2025. The data came from pharmacy organizations and were processed by Pharma Data Factory before being combined with information held by the Italian Medicines Agency.

Using sell-out data provides a clearer view of medicines actually dispensed to citizens. It also avoids some of the limitations of sell-in figures, which can be affected by stock accumulation or disposal in pharmacies.

The Italian Medicines Agency said the report is intended to support a better understanding of medicine use, prescribing behavior, demographic change, and regional disparities. The findings may also assist policymakers in evaluating pharmaceutical strategies, encouraging appropriate prescribing, and planning future healthcare interventions.