As a key component of health care, a full understanding of how much is spent on prescription medicines is increasingly important. Only a partial understanding of total expenditures across health systems is currently possible, as reporting is often limited to medicines dispensed in community pharmacies. However, spending on pharmaceuticals used elsewhere in the health sector, particularly in hospitals, constitutes a significant and growing proportion of the overall resources allocated to medicines. This report aims to improve the coverage and quality of data on total pharmaceutical spending across the whole health sector, by reviewing current practices, and recommending a set of definitions, concepts and guidance under the framework of A System of Health Accounts 2011. Countries are encouraged to apply these guidelines in their future reporting of pharmaceutical expenditures, as part of their annual health accounts data production.