This retrospective study was conducted to evaluate all‐cause healthcare resource utilization (HCRU) and costs in commercially insured patients living with pulmonary arterial hypertension (PAH) and explore end‐of‐life (EOL)‐related HCRU and costs. Data from the IQVIA PharMetrics® Plus database (October 2014 to May 2020) were analyzed to identify adults (≥18 years) with PAH (PAH cohort) and those without PH (non‐PH cohort). Patients were required to have data for ≥12 months before (baseline) and ≥6 months after (follow‐up) the first observed PH diagnosis (index date) for PAH cohort or pseudo index date for non‐PH cohort. A PAH EOL cohort was similarly constructed using a broader data window (October 2014 to March 2022) and ≥1 month of follow‐up. Annualized all‐cause HCRU and costs during follow‐up were compared between PAH and non‐PH cohorts after 1:1 matching on propensity scores derived from patient characteristics. EOL‐related HCRU and costs were explored within 30 days and 6 months before the death date and estimated by a claims‐based algorithm in PAH EOL cohort. The annual all‐cause total ($183,616 vs. $20,212) and pharmacy ($115,926 vs. $7862; both p < 0.001) costs were 8 and 14 times higher, respectively, in the PAH cohort versus matched non‐PH cohort (N = 386 for each). In PAH EOL cohort (N = 28), the mean EOL‐related costs were $48,846 and $167,524 per patient within 30 days and 6 months before the estimated death, respectively. Hospitalizations contributed 58.8%–70.8% of the EOL‐related costs. The study findings indicate substantial HCRU and costs for PAH. While pharmacy costs were one of the major sources, hospitalization was the primary driver for EOL‐related costs.