This guide is designed to take country-level pharmaceutical and financing experts through the System of Health Accounts (SHA) framework as a potential approach that can be adapted to track pharmaceutical expenditures. The guide also reviews important first steps that must be considered to operationalize pharmaceutical expenditure tracking. It is intended to serve as a foundation for a wider conversation about pharmaceutical expenditure tracking approaches and to bring attention to key normative issues including expenditure definitions and boundaries that will need to be addressed before full-scale implementation guidelines for pharmaceutical expenditure tracking can be fully adopted.