OBJECTIVES:  The National Pediatrics Total Parenteral Nutrition Program started in 2013 at General Administration of Pharmaceutical Care in Saudi Arabia. The pharmacist can prescribe Pediatrics Total Parenteral nutrition (TPN) order. The study stimulation of estimated cost avoidance of pharmacist running pediatrics TPN services by using American Model with local cost METHODS:  Simulation of 17-hospitals had pediatrics TPN services. A 300- Bed Hospital with 6-month TPN services for pediatrics in 2015. The cost of TPN services estimated by variable expenses including personal cost, material and supply cost. Fixed costs including overhead cost and non-salary cost. All cost calculation used US dollar currency. The cost drives from Ministry of Health information database. TPN services started from prescribing, preparation, dispensing, administration, and follow-up, and discounted the TPN order. Cost avoidance stimulation of pharmacist running pediatrics TPN services at seventeen hospitals in Saudi Arabia RESULTS:  The total number of TPN Prescription 38 per day, and 13,870 TPN prescription per year. The total estimated cost of TPN services run by a physician (773.8 USD) per day while (710.45 USD) per day If the TPN services led by the pharmacist. The total estimated expenditures of TPN services by a physician (10,732,606 USD) annually. The total estimated costs of TPN services run by the pharmacist (9, 853, 941. 5 USD) annually. The annual estimated cost avoidance was (878,664.5 USD) and (63.35 USD) per each TPN order. CONCLUSIONS: Pediatrics Total Parenteral Nutrition cost-avoidance simulation for Saudi Arabia, it first study conducted in Saudi Arabia, Gulf and Middle East countries. It estimated cost savings per each TPN order. Expanding the pediatrics TPN services runs by pharmacist associated with cost avoidance simulation for pharmacy and healthcare system