OBJECTIVE: To understand how pharmacy spending varies across the VA Medical Centers in the United States. Pharmacy costs continue to rise. From 1990 to 1994 pharmacy expenditures were reported to be 6% of the total Veteran's Health Association (VHA) budget. In 1995 and 1996 it was 7%. In 1997 it was 8% and in 1998 it was 9%. Then in 1999 it went to 11%. Future projections are for a continued increase in budget spending. METHODS: Ratios of yearly Pharmacy to Medical Center expenditures were compared.These ratios were ranked and compared with geographical location. The years of 1997 and 1998 were studied. RESULTS: The majority of the highest ratios were located in the Midwest, Soutwest, and Southern regions of the United States. CONCLUSIONS: Financial ratios can demonstrate variations in expenditures and identify areas that may require further inquiry.