OBJECTIVES: Pasireotide is a novel, injectable multireceptor-targeted somatostatin analogue that binds with high affinity to four of the five somatostatin receptors. It has been commercially available in Europe since May 2012 and is the first pituitary-targeted medical therapy indicated for adult patients with Cushing’s disease (CD) for whom surgery has failed or is not an option. This analysis aims to quantify the budget impact (BI) of utilizing pasireotide as second-line therapy in CD in Germany. METHODS: A thorough chart audit was conducted to analyze resource utilization and market shares of standard of care in CD. Epidemiology, treatment response complications and adverse event (AE) data were derived from published literature. Pasireotide data were taken from a Phase III clinical trial. German tariffs for each resource were then applied to an Excel-based model to compare utilization and costs with and without the introduction of pasireotide (net BI) for patients with CD over a 5-year horizon from the German healthcare system. RESULTS:  Applying a CD prevalence rate of 39 per million and the treatment success of first-line therapy, fewer than 200 patients with CD are eligible for pasireotide treatment in Germany. Assuming that pasireotide in years 1–5 will have a market share of 8%, 15%, 23%, 25% and 26%, the net BI is 812,769€, 549,676€, 1,553,976€, 2,088,511€ and 2,209,948€, respectively. Budget impact is reduced by early identification of pasireotide non-responders, low cost of treating pasireotide AEs, and potential displacement of second-line surgical treatments such as bilateral adrenalectomy. Pasireotide BI may be further minimized if offsets due to lower consumption of health care resources in controlled patients are considered.    CONCLUSIONS:  The introduction of pasireotide into the German healthcare system will result in clinical benefits for CD patients associated with a limited and predictable BI.