OBJECTIVES: Analyses were conducted on Republic of Srpska (RS) Health Insurance Fund (HIF) national prescription database. Analyses explored health expenditure in pharmaceutical consumption of oncology medications for the fiscal year 2005 through 2012, in order to determine impact of introduction of public tenders in 2008. RS HIF provides coverage for a population of 1.2 million. METHODS: RS HIF national prescription database was explored. Key cost drivers and the differences were identified across all medications covered by the RS HIF. RESULTS: In 2005, total expenditure for all Oncology medication was €1.2 million. In 2012, total expenditure for all Oncology medications was €8 million. This increase of 681% is a result of two critical factors: 1) a national policy shift in 2004, of patient treatment switch from being treated abroad in Republic of Serbia to being locally treated; 2) exponential increase in Oncology indications incidence. In 2008 there was an introduction of public tenders that run every two calendar years, which allowed additional medications to be purchased by the RS HIF, as well at lower costs and hence it resulted in moderate decrease in expenditures, even though there was a steady increase in quantities purchased. This resulted in balanced and average expenditure from 2008 to 2012 of €9 million. Based on 2005 through 2012 consumption of Oncology medications, it is derived that over the years to date, top three Oncology indications are: a) Metastatic breast cancer, b) Metastatic colorectal cancer, c) Colorectal cancer Stage III. CONCLUSIONS: Results indicate that most of the patients treated abroad, transferred back to RS HIF for treatment by 2008. Top three Oncology indications show that there is a need for higher public awareness and patient education in RS related to them.  This is in line with current RS public healthcare policies and strategies.