OBJECTIVES: The National Total Parenteral Nutrition Program started in 2013 at General Administration of Pharmaceutical Care in Saudi Arabia. The pharmacist-managed Neonates Total Parenteral nutrition (TPN) services. The study objective was stimulation of estimated cost avoidance of pharmacist-managed neonates TPN services by used American Model with local cost. METHODS: Simulation of 17-hospitals had Neonates TPN services. A 300-Bed Hospital with 6-month TPN services for infants 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. The cost derived 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 neonates TPN services at seventeen hospitals in Saudi Arabia calculated of all TPN stages. All cost calculation used by US dollar currency. RESULTS: The total number of TPN prescription was (176 per day) and (74,240 TPN orders per year) for a total seventeen hospitals. The total estimated cost of TPN services managed by a physician was (863.74 USD) per day; while the cost of (786.75 USD) per day if the TPN services run by the pharmacist. The total estimated expenditures of TPN services by a physician (64,124,057.6 USD) annually. The total estimated costs of TPN services managed by the pharmacist (58,408,320 USD) annually. The estimated cost avoidance was (5,715,737.6 USD) annually and (13,550.24 USD) per day. The estimated cost saved was (76.99 USD) per each TPN prescription CONCLUSIONS: In this Neonatal Total Parenteral Nutrition cost-Avoidance simulation for Saudi Arabia, it is with cost savings per each prescribing TPN order. Expanding of pharmacist-managed TPN services for neonates associated cost avoidance simulation for healthcare services.