OBJECTIVES The emergence of more resistant fungal pathogens necessitated development of new antifungal agents. Three new antifungal medications (caspofungin, anidulafungin, voriconazole) entered the healthcare market from 2001-2006. The objective of this study is to describe the impact of these new agents on drug utilization and charges in a single health care system. METHODS Retrospective descriptive analyses were conducted to describe trends in utilization of and charges associated with antifungal medications in a 7-hospital health-system from 2005-2007. Data was obtained from the hospital accounting/inventory management systems. The new antifungal agents were compared to traditional ones (amphotericin B, fluconazole, itraconazole). The proportion of total charge and total doses of each antifungal were calculated as proxies of market share and utilization, respectively. Charge data were converted to $2007 using the medical component of the CPI. RESULTS Total doses dispensed were 51,845 to 12,471 patients. Utilization of new antifungal agents was 29%, 22% and 29% of antifungal medications in 2005, 2006 and 2007. These newer drugs, however, comprised 71%, 55% and 61% of total antifungal charges in these years. Amphotericin B/liposomal amphotericin B increased utilization by 79% (2.5-4.3%) and increased market share 200% (8-22%) despite a reduction in mean charge/dose ($632 in 2005 and $610 in 2007). Fluconazole IV use dropped from 18% to 9% with corresponding reduction in percent total charges from 10% to 7% (mean charge/dose $111 in 2005, $98 in 2007). Oral fluconazole had the largest utilization of all antifungals (50-56%). Its market share remained fairly constant (10%, 12%, 9% 2005-2007) with decreased mean charge/dose from $37 to $18. Itraconazole, oral and IV, accounted for very little market share and utilization. CONCLUSIONS Use of cost containing strategies and formulary management in real world practice have restricted growth of market share and utilization of new antifungal agents and encouraged use of traditional medications.