OBJECTIVES:  To explore the prescribing and medication management practice at Ministry of Health (MOH) hospitals in Saudi Arabia METHODS:  It is a 4-months cross-sectional national survey of prescribing and medication management at MOH hospitals in Saudi Arabia. The study consisted of two-part a demographic information, and the second part contained eighty-five questions divided into six domains drove from American Society of Health-System Pharmacists (ASHP) survey. The parts were pharmacy management and resources, prescribing and medication management, preparation of medicines and dispensing, technology and clinical pharmacy services, drug monitoring and patient education, and pharmacy education and training. The 5-points Likert response scale system closed and ended questions used. An electronic questionnaire distributed to the one hundred eighty-five directors of pharmacies at MOH hospitals, and it analyzed the prescribing and medication management section through survey monkey system RESULTS:  The total responders were seventy hospital pharmacies; the repose rate was (37.73%). The highest score of committee shared by the hospital pharmacy was the pharmacy and therapeutic committee (4.32), quality management committee (4.21), and patient or medication safety committee (4.03). Also, the hospital pharmacies actively participated in the antibiotics team (3.19) and pain management team (2.07). The most therapeutic guideline available in the hospital pharmacies were antibiotics guidelines (2.93) and infection control guidelines (2.81). The majority formulary management method used was restricted prescribing 23 (32.9%), and review of non-formulary drugs prior approval 13 (18.6%). The pharmacist had the privilege to write medication orders were 14 (20%) only. The pharmacist commonly prescribed over the counter medications 14 (58.3%) and antibiotics 13 (50%) through the prescription consigned by physicians 38 (54.3%) and drug prescribing protocol 28 (40%). CONCLUSIONS:  The pharmacist seldom participated in the therapeutic committees or teams although he had an excellent role of providing medication information. Expanding pharmacy activities will improve the prescribing system, patient clinical outcomes, and prevent drug misadventures.