Neopicrorhiza scrophulariiflora (Pennell) D. Y. Hong of Scrophulariaceae family (hereinafter referred to as Neopicrorhiza) has medicinally important rhizomes with high levels of trade. What factors drive demand for Neopicrorhiza in Central Himalaya is unknown. In this context, a nationwide comprehensive survey was conducted from September 2016 to March 2017 to assess demand, end-uses, and conservation of dry Neopicrorhiza rhizomes in Nepal. A total of 2313 herbal products were surveyed for Neopicrorhiza as an ingredient in 38 retailer shops. Processing industries of Neopicrorhiza in Nepal were interviewed using structured questionnaire. There were 23 herbal industries manufacturing 45 types of ayurvedic medicines as end-products containing Neopicrorhiza. The volume and value of annual demand for dry rhizomes of Neopicrorhiza in Nepal were found as 6076 kg and NRs 8573236 (USD 83235.30), respectively, in 2015/016 with average 264.17 kg/industry and NRs 1410.87 (USD 13.69) per kg. The major uses of ayurvedic medicines containing Neopicrorhiza were to treat a number of disease categories: cardiovascular system/liver (17), cardiovascular system/blood (6), nervous system (6), dermatological system (4), musculoskeletal system (3), digestive system (2), respiratory system (2), genitourinal system (4), and others (1). Despite changing legal regulation, trade and consumption of Neopicrorhiza exist in Nepal. It can be concluded that domestic consumption is not the major cause of resource depletion of Neopicrorhiza in Nepal.