OBJECTIVES: Scarcity of public resources, especially in challenging economic times, draws attention to the expenditure on pharmaceuticals. Over the next 3 years the Hungarian government plans to reduce the public pharmaceutical spending by 35%. Our objective was to assess the current level of pharmaceutical expenditure in Hungary by taking into account the economic status of the country and benchmarks from other OECD countries with special focus on Visegrad countries (Czech Republic, Slovakia, Poland, Hungary). METHODS: We completed international cross sectional and cluster analysis based on OECD Health Data 2010 and longitudinal analysis of public pharmaceutical expenditure in Hungary. RESULTS: The cluster analysis indicates that pharmaceutical spending is relatively higher in middle-income countries compared to high income countries above 30’000 USD GDP/capita (1.89 vs. 1.41% of GDP%, p=0.04; 23.58% vs. 14.14% of total health expenditure, p<0.001), as prices of pharmaceuticals are not adjusted to local price levels as opposed to prices of other health care services. International trends of the global pharmaceutical market are also valid in Hungary. The public pharmaceutical spending is close to the average of Visegrad countries, but the private pharmaceutical spending is the highest. The annual real growth rate of public pharmaceutical spending was only 1.0% between 1994-2010, whilst increased private funding (mainly out of pocket payments) was the major growth driver of total pharmaceutical expenditure in Hungary. CONCLUSIONS: Cost-containment of public pharmaceutical spending was very successful in the last 15 years. The burden of pharmaceutical market growth has been shifted to private households. The proposed public budget cut translates to over 30% decrease in real public pharmaceutical spending from 1994 to 2014. As morbidity and mortality indicators of the Hungarian population are extremely unfavourable, current evidences and international benchmarks do not justify significant reduction of the public pharmaceutical budget.