OBJECTIVES To analyze medication costs and utilization in hospice care using PBM claims data from hospices in Ohio. METHODS A retrospective analysis was conducted using claims from January 1 through December 31 2007 from five hospices in Ohio. The data contains information regarding prescription medication utilization and their costs. Descriptive analyses were conducted to identify ten therapeutic drug classes with the most frequent utilization rates and largest percentage of expenditures. Further, descriptive analyses were conducted to examine the differences in prescription drug count and total cost by therapeutic class and by drug name for each hospice and for all hospices combined. RESULTS The average number of admissions in each hospice for the calendar year 2007 was 527, 50.6% being male. The drug expenditures for each hospice averaged $498,301 per year. Approximately 1020 different medications under 246 therapeutic classes were found to be utilized in the five hospices. The most frequently utilized therapeutic class of medications, based on prescription medication count included analgesic-narcotics (14.9%) followed by laxatives-cathartics (7.2%), and anti-anxiety drugs (6.7%). Therapeutic classes contributing to the majority of drug expenditures included opioid analgesics (16.5%), SSRIs (4.7%), and anti-anxiety drugs (4.5%). Medications whose frequency of use contribute to significant expense include morphine sulfate (5.3% - utilization & 4.4% - expenses), and lorazepam (4.4% & 3.1%.). Individual drug products not frequently utilized, although significantly contribute to expenses include fentanyl (3.5%) and low molecular weight heparin products(3.1%). CONCLUSIONS Although the overall costs for hospice care to Medicare and patients is less as compared to the costs incurred by conventional non-palliative focused care, the cost for medications in a hospice program is significant. Hospices should place emphasis on the utilization of cost effective drugs that can be used among terminally ill patients to provide a high level of quality care with fiscal responsibility.