OBJECTIVES:  The Total Parenteral Nutrition (TPN) preparations cost estimation and forecasting is a part of the pharmacy strategic planning at MOH in Saudi Arabia. The study investigated the cost analysis of TPN preparations and forecasting in 2016-2020 METHODS:  Simulation of 6-month 2015 cross-sectional of TPN (2 in 1) preparations for neonates, pediatrics, and adults patients. It was at 300-Bed Hospital (King Salman Hospital) in Riyadh, Saudi Arabia. The pharmacist reviews and prepared TPN. TPN developed through sterile 797 standards and automated compounding facilities. The cost drives from Ministry of Health information database. All price used US dollar currency and local prices. RESULTS:  The total number patients were 112 with 1631 TPN orders. The estimated cost of TPN bag for adult per day was (265.95 USD). The estimated cost of TPN preparations for pediatrics per day was (284.35 USD). The estimated cost of TPN preparations for neonates was (250.64 USD). The average break-even points after establishment TPN room was 4-months only. The forecasting cost with additional 30% revenues. TPN prices for adults was (345.73 USD), pediatrics (369.65 USD), and neonates (325.8 USD). The break-even points after new price occur after 3-months only. The automated TPN compounding system should use for hospital if at least had an average of eight to ten TPN preparations per day CONCLUSIONS:  Cost analysis and forecasting of Total Parenteral Nutrition prices is part pharmacoeconomics program and vision future 2030 at MOH in Saudi Arabia. It is an essential tool for TPN strategic plan, forecasting of new TPN services, and cost estimated of TPN-related health care services.