The most up-to-date snapshot of medicine use in Italy comes from the 2024 Regional Reports published by Agenzia Italiana del Farmaco (AIFA). These reports analyse consumption and expenditure at a territorial level and currently represent the most accurate reference for understanding regional dynamics.
This is not merely a statistical update, but a lens through which to observe how the Italian pharmaceutical system actually works: not as a uniform structure, but as the sum of diverse regional models.
Stable consumption, shifting therapeutic mix
The first key finding is the stability of consumption. Italy remains at consolidated levels, with around 1.9 defined daily doses per capita, in line with previous years.
However, this stability can be misleading.
The mix of medicines being used is changing significantly.
What is increasing is not volume, but the weight of high-complexity therapies, particularly:
- oncology drugs
- immunomodulators
- treatments for chronic conditions
The result is a system with broadly unchanged consumption levels, but a more sophisticated therapeutic profile.
Spending is rising, but not due to inefficiency
According to the latest available data (OsMed Report), total pharmaceutical expenditure has exceeded €37 billion, showing moderate growth compared to the previous year.
This trend is not driven by an indiscriminate increase in prescriptions.
Rather, it reflects the combined effect of three factors:
- the introduction of high-cost innovative therapies
- the growing burden of chronic conditions linked to an ageing population
- a broader level of care provided by the National Health Service
The system, therefore, is not out of control.
It is undergoing a structural transformation.
Regional variability remains the most critical issue
This is precisely where the AIFA Reports become crucial.
Differences across regions remain significant and concern:
- levels of consumption
- per capita expenditure
- prescribing appropriateness
- uptake of generics and biosimilars
In some areas of the country, a more efficient use of resources can be observed, with wider adoption of generic medicines. In others, higher consumption levels persist, along with a greater share of out-of-pocket spending.
This is not a new issue, but it remains unresolved.
And it continues to represent one of the system’s main points of tension.
Public and private, a balance being reshaped
In 2024, around 70% of pharmaceutical expenditure is covered by the National Health Service, while more than €10 billion remains directly borne by citizens.
This is not simply a rise in private spending.
It is a redistribution of responsibilities:
- the public sector focuses on high-value, high-cost therapies
- citizens bear an increasing share of non-reimbursed medicines
While this model improves overall system sustainability, it also raises important questions in terms of equity.
Appropriateness, the unresolved issue
If volumes remain stable and spending grows in a controlled manner, the real issue becomes appropriateness.
Regional data still show:
- prescribing differences that are not always justified
- uneven levels of adherence to therapies
- variability in the use of certain drug classes, such as antibiotics
In this context, medicines become an indicator of the overall quality of the healthcare system, rather than simply a cost item.
A system under control, but not yet integrated
Overall, the picture that emerges is less critical than one might expect.
The Italian pharmaceutical system:
- keeps consumption under control
- absorbs innovation
- remains sustainable
Yet it is still fragmented.
Spending is not the real issue.
The challenge lies in ensuring uniform access, appropriateness, and quality of care across the entire national territory.
This is where the next phase of the system’s evolution will be decided.
