OBJECTIVES: To analyze determinants of recent evolution of DMT consumption for MS in Spain. METHODS: Available DMT market data comprised monthly figures for the period 2004-2012. Monthly and annual evolution of consumption, treated patients and annual cost of treatment were calculated for each DMT. This analysis was replicated for first-line (intramuscular and subcutaneous interferon (IFN) β-1a, subcutaneous IFN β-1b, and glatiramer acetate) and second-line therapies (natalizumab and fingolimod). Evolution of these variables was analyzed for both the whole period 2004-2012 and since 2007 (when second-line therapies become available in Spain). RESULTS: DMT expenditure in Spain increased by 147% in 2004-2012 (from €115.5M to €284.9M, 11.95% annually). This evolution can be decomposed into: the growth in the figure treated patients (126%; 10.70% annually) and the increase in the average annual cost per patient (9%, from €11,739 to €12,839; 1.13% annually). For 2007-2012 subperiod, DMT spending increased by 73% (11.57% annually) is attributable to 59% more treated patients (9.73% annually) and an increase of 9% (1.68%) in annual cost per patient. Cost per patient in second-line is 70% higher (average 2007-2012) than average cost per treated patient (€ 21,074 vs. € 12,372) and 82% higher than annual cost of first-line therapy (€ 21,074 vs. € 11,549). Between 2007 and 2012, second-line therapies accounted 32% of new treatments and 48% of incremental cost per patient. By omitting year 2007 from analysis (68 second-line treatments and €1.44M associated consumption), second-line therapies account for 38% of new treatments and 55% of incremental cost per patient. By 2012 second-line therapies already represent 50% of new treatments and 67% of DMT cost increase. CONCLUSIONS: The increase of patients treated with DMT in Spain (10.70% annually in 2004-2012), more costly new therapies incorporation and its growing consumption are crucial factors in handling hospital pharmacy budgets for prevalent diseases such as MS.