Pharmaceutical policy and market in Iran: past experiences and future challenges

Objectives All health systems around the world have faced rising pharmaceutical expenditures which threaten the ability of the national health systems to deliver good quality care in an equitable manner. The aim of this paper is to consider the pharmaceutical market and relevant government policies in Iran, which may have broader resonance with similar issues in other middle income countries. Methods This study used mixed methods. Asystematic literature search was undertaken to identify relevant publications. This was supplemented by hand-searching in local books and journals, including Iranian Government publications. The issues and uncertainties identified were explored further qualitatively, by semi-structured interviews with key informants. Sixteen interviews were conducted. The interviews were recorded, transcribed, coded, classified and analysed thematically. Key findings The systematic review identified the history and some elements of the structure of the pharmaceutical market in Iran. The grey literature expanded this and also identified issues to be explored further in the interviews. The literature review showed how past challenges forced changes to pharmaceutical policy in Iran. It also showed that the Iranian 'Generic Scheme' (started in 1980) was very successful in improving accessibility to pharmaceuticals, particularly in the 1980s. However, recent policies have created new challenges in the Iranian pharmaceutical market. The interviewees highlighted these as: increasing pharmaceutical utilisation, rising pharmaceutical expenditures and the lack of a unifying clear pharaceutical policy. Empirical evidence also supported the points raised by the subjects. Conclusions The first and most important step toward solving the challenges should be a feasible, reasonable and comprehensive policy. This could help pharmaceutical policy makers to keep the benefits gained from the 29-year Generic Scheme in Iran.