OBJECTIVES: This analysis was designed to estimate the budget impact following the introduction of apremilast in the treatment of adult patients with moderate to severe psoriasis who have failed to respond to, have a contraindication to, or are intolerant of other systemic therapy in Spain. METHODS: A budget impact model was developed to estimate healthcare costs for adults with moderate to severe psoriasis over 3 years from the NHS perspective. Target population was defined based on epidemiological criteria; psoriasis prevalence (2.30%) and proportion of patients on biologic treatment (18%) were applied to national adult population statistics. Addition of apremilast to the therapeutic arsenal (adalimumab, etanercept, infliximab, ustekinumab) was explored. From the annual eligible psoriasis population (N=16,322), 5% (n=816), 11% (n=1,795), and 18% (n=2,938) were assumed to be treated with apremilast for the first, second, and third years. A local expert panel provided detailed resource consumption information. Total cost included drug acquisition based on drug doses from summaries of product characteristics (ex-factory price with mandatory deduction), administration (parenteral drugs), and monitoring costs. Unitary costs (€, 2014) were obtained from national databases. RESULTS: Total budget for the scenario without apremilast was €193,677,634, €192,945,426, and €192,077,291 in the first, second, and third years. Pharmaceutical cost represented 95% of the total. Following apremilast introduction, total budgets were reduced by €2,194,450, €4,827,791, and €7,900,021 in the first, second, and third years. Incremental drug costs/patient comparing the scenario with apremilast vs. without apremilast were €−134.44 (−1.13%), €−295.78 (−2.50%), and €−484.00 (−4.11%) in the first, second, and third years. CONCLUSIONS: Apremilast treatment for psoriasis patients who have failed to respond to, have a contraindication to, or are intolerant of other systemic therapy would imply a budget impact decrease on overall healthcare expenditure for NHS. This analysis was limited in that the model did not consider cost-effectiveness issues.