This study examined out-of-pocket (OOP) expenditures on medications among adults in Saudi Arabia using data from the 2018 Family Health Survey. The average OOP expenditure was estimated at 279.69 Saudi Riyals. Key determinants of OOP spending included age, household income, education level, and chronic conditions, while being married and employed correlated with lower expenditures. These findings can guide policymakers in enhancing insurance coverage and benefits to reduce OOP costs, especially for vulnerable groups.