OBJECTIVES: Costs of cancer treatment has received increased attention in the last decade mainly because of the very high expenses on new biological drugs. Total cancer treatment costs vary by tumor type and stage, with the highest costs usually incurring in the last year of life. In this study, we characterized the drugs that have the highest budget-impact in treating cancer patients in Israel, immediately before death. METHODS: Clalit Health Services (CHS), Israel’s largest health-care organization with over 4 million members, serves 52% of the total population.  Using CHS's comprehensive databases, we identified the three leading fatal cancers in 2012. We calculated CHS's acquisition costs for all pharmaceuticals provided to patients in their last three months of life, and extracted the top budget-consuming drugs used during this period.  RESULTS: The leading fatal cancers in 2012 were colorectal (1551 deaths), breast (1273) and lung cancer (1174). The drugs with the highest budget-impact in colorectal cancer patients were (% of total drug-expenditure, # of patients treated (% of the total number of patients)): Cetuximab (20.2%, 38 patients (2.5%)), Bevacizumab (14.6%, 56 patients (3.6%)), Panitumumab (6.6%, 21 patients (1.4%), Fentanyl (6.5%, 278 patients (17.9%)), Irinotecan (4.0%, 77 patients (5.0%)). In breast cancer: Trastuzumab (12.0%, 23 patients (1.8%)), Fulverstant (6.4%, 42 patients (3.3%), Fentanyl (5.9%, 178 patients (14.0%)), Lapatinib (5.5%, 10 patients (0.8%)), Zoledronic acid (4.1%, 59 patients (4.6%)). In lung cancer: Erlotinib (21.4%, 77 patients (6.6%)), Gefitinib (12.8%, 42 patients (3.6%)), Pemetrexed (10.5%, 57 patients (4.9%)), Crizotinib (6.0%, 8 patients (0.7%)), Fentanyl (4.5%, 298 patients (25.4%)). CONCLUSIONS: A significant proportion of the pharmaceutical budget was spent on a relatively small portion of patients who received expensive novel targeted therapies during their last months of life although chances for success were minimal. A much higher portion of patients received palliative treatments for a substantially smaller proportion of the pharmaceutical expenditure.