ISSUE: Healthcare systems are under pressure to contain expenditure in the face of demographic and technological change. Policy-makers are increasingly focused on pharmaceutical prices as a source of the pressure on healthcare budgets. Data on historic and forecast growth of total pharmaceutical expenditure is therefore an important factor in this debate.Tim Davis will discuss historical and forecast pharma expenditure data covering a period from 2011 to 2021. This data is based on QuintilesIMS (QI) methodology using list prices and audited pharmaceutical volumes. Claudio Jommi will discuss the recent trends for managed entry agreements to set an increasing divergence between list and net prices in Europe. The impact on the expenditure data forecasts will be presented and set in the context of the broader macroeconomic situation. Panos Kanavos will discuss the broader implication of the analyses and address the question of what level of pharmaceutical expenditure in Europe is sustainable, and the implications for healthcare and pharmaceutical policy in Europe OVERVIEW: Forecasts for pharmaceutical expenditure are notably absent from the policy debate on drug prices in Europe. There are several sources of expenditure (e.g. OECD) but few forecasts which policy-makers and budget holders can use to, as accurately as possible, predict future needs. QuintilesIMS provide forecast data for the big 5 European pharmaceutical markets based on publicly available list prices of pharmaceuticals applied to audited volume data. This data shows a compound annual growth rate (CAGR) of 3% over the next 5 years. An initial assessment based on OECD and QI data suggests that the net figure could be 1 to 2% lower. The implications for pharmaceutical policy will be explored by the panelists and the question of what constitutes a sustainable growth rate in expenditure on pharmaceuticals will be set against the broader question of how much society should spend on healthcare.