Hemodialysis patients take an average 12 medications (10 at home, 2 in clinic). Cost associated with clinic medications is estimated at 8,429 dollars per patient year at risk, but the medication cost associated with home medications is unknown. Our objective was to determine an estimate of the cost of home medications in the hemodialysis population. Point-prevalent patient medication use data (Jan. 1, 2003) from the Dialysis Clinic Inc. (DCI) national database was used for the study. All patients were classified as patients with diabetes (DM) or patients without diabetes (nonDM), and medication orders were divided into home and in-clinic medications. Home medications were classified as brand (B), generic (G), or brand that could be generic (BG). All home medications were further subcategorized into 12 therapeutic classes. National average medication cost for brand (76.29 dollars) and generic (22.79 dollars) medications were applied to the orders. The medication profiles of 10,230 HD patients were surveyed. Overall, patients were on a mean of 10.1 +/- 4.6 home medications. Currently, 53.4% of the health care dollar is spent on cardiac, gastrointestinal, and phosphate binding medications. DM patients spent significantly more on cardiac, gastrointestinal, and endocrine/hormonal agents (all p < 0.001) whereas nonDM patients spent more on anti-infective agents, analgesics, and phosphate binders (all p < 0.05). Medications for HD patients cost 16,000 dollars per patient per year. Health care providers should be aware of the medication cost burden in HD patients. Efforts to decrease this burden, whether through pharmaceutical care, generic prescribing, or sampling programs, should be considered.