Iran’s renewed currency slide and restrictions on maritime trade are intensifying pressure on a pharmaceutical system already struggling with rising prices, financing shortages and delayed insurance payments. As the dollar traded above 230,000 tomans on September 9, Iran’s Health Insurance Organization announced that it had incorporated the latest medicine price increases into its reimbursement systems. Together, these developments highlight the challenge facing patients: keeping medicines available while ensuring that families can still afford them.
Drug prices were already climbing before the latest currency movement. In an August 28 interview, Hadi Ahmadi, spokesperson for the Iranian Pharmacists Association, estimated that prices had increased by an average of about 80 percent since the Iranian year began in March, with some products registering increases of 300 percent. These figures represent the association’s assessment rather than a published national price index. They do not establish an equivalent increase in every patient’s payment, which depends on insurance coverage, but indicate the burden confronting institutions expected to protect patients.
The connection between the dollar and the pharmacy bill is significant but uneven. Iran maintains multiple exchange rates, including subsidized currency for eligible pharmaceutical imports. An April announcement retained a rate of 28,500 tomans per dollar for qualifying pharmaceutical and medical imports, with the central bank supplying currency from government revenues associated with oil and gas exports. The free-market rate therefore cannot simply be used to calculate the cost of every imported medicine.
The crucial question is whether companies receive their allocations and can transfer payment to suppliers. A September 1 report by Mehr emphasized the distinction between approved foreign currency and usable funds. Domestic manufacturers also need imported ingredients, equipment and other inputs. Producing a medicine inside Iran does not eliminate exposure to currency shortages or international supply disruptions.
The widening gap between subsidized and other exchange rates makes access to preferential allocations increasingly consequential. A manufacturer forced to purchase inputs through a more expensive channel needs additional financing before producing its next batch. September’s dollar jump adds pressure to a system already struggling to absorb earlier increases, even where regulated prices do not change immediately.
The blockade creates a separate logistical constraint. Pharmaceutical ingredients and equipment must reach Iran through functioning transport routes, and replacing disrupted routes can require more time and money. Ahmadi warned that prolonged maritime restrictions would make alternative arrangements costlier and could eventually produce shortages. His warning concerned the sustainability of supply rather than demonstrating that all medicines were already scarce.
Health officials say alternative routes and emergency shipments have helped sustain supplies. Health Ministry spokesperson Hossein Kermanpour recently described measures combining strategic reserves, alternative suppliers, domestic manufacturing and the prioritization of essential products. Some reserves had been released to meet immediate needs, while emergency air shipments had entered when regular arrangements proved inadequate. These measures show that supplies are still reaching Iran, although they do not establish that substitute routes can deliver the same volumes at the same cost indefinitely.
Kermanpour also acknowledged that vulnerabilities predated the war. Delays in foreign-currency transfers, funding allocations and price adjustments had already strained pharmaceutical companies. Wartime transport restrictions, damage to factories and disruptions to raw-material supplies then added further difficulties. Companies waiting for funding have less flexibility to finance expensive alternative shipments, while longer delivery schedules complicate production planning.
Health Minister Mohammad-Reza Zafarghandi has similarly attributed rising costs to transportation, pharmaceutical inputs and packaging materials. In remarks reported earlier this month, he argued that restrictions on shipping and flights affect medicine supplies even when medicines themselves are described as exempt from sanctions. He maintained that shortages had not worsened relative to the period before the war, yet availability is also distinct from cost.
Patient advocates have described the consequences more directly. In an interview published by Iran Unfiltered on August 24, Amin Afshar, chairman of the Iranian Hemophilia Society’s board, told interviewer Maryam Shirinsokhan that severe shortages affected around 4,000 patients, including people with Factor XIII deficiency and severe von Willebrand disease. He described obstacles involving banking, shipment insurance, transportation, export approvals and companies’ fears of secondary sanctions.
Afshar cited an attempted donation by the World Federation of Hemophilia that, he said, never reached Iran because the necessary approvals were not granted—even though no commercial payment was involved. He also acknowledged domestic problems, including delayed currency allocations, insurance difficulties and bureaucracy. His account underscores how external restrictions and domestic failures can reinforce each other, with patients bearing the consequences.
Other patient representatives had raised similar concerns earlier this year. At an April 27 gathering, Ahmad Ghavidel, a former director of the Iranian Hemophilia Society, criticized the contradiction between declaring medicines exempt and restricting the shipping and payment channels needed to obtain them. Masoumeh Sadeghzadeh Boroujeni, the society’s managing director, likewise said banking and freight-insurance restrictions obstructed imports and access to newer treatments.
That discussion also demonstrated differences between patient groups. Younes Arab, head of the Iranian Thalassemia Association, criticized barriers to newer medicines and wartime transport disruptions, but said expanded insurance coverage had prevented increases in copayments for foreign thalassemia medicines at that time. Effective coverage can therefore protect patients even when underlying prices rise.
For people requiring repeat prescriptions, affordability remains a continuing concern. An increase can become a recurring household expense. Maintaining supplies through costlier routes may prevent shortages while leaving the financial burden unresolved. The response depends on how additional costs are distributed among suppliers, insurers, public subsidies and families.
The September 9 insurance announcement addresses part of that chain. Maryam Azadi, the Health Insurance Organization’s director for specialized and subspecialized services, confirmed that several rounds of medicine price increases had occurred since March. The latest revisions had been incorporated following notification from the Supreme Health Insurance Council. Her statement did not provide a breakdown of patients’ payments or explain whether those who had already paid higher charges would receive reimbursement.
Hossein-Ali Haji-Deligani, deputy chair of parliament’s Article 90 oversight commission, said revised prices for medicines including mercaptopurine and amphotericin B were reaching pharmacies before corresponding insurance coverage became operational. Patients were being required to pay the difference, potentially facing elevated expenses for as much as a month. He proposed updating insurance systems before pharmacies applied new prices. Patients needing continuing treatment cannot necessarily wait for those adjustments.
The issue becomes more consequential as officials debate pharmaceutical subsidies. Economy Minister Ali Madanizadeh has called for a support arrangement that would permit the removal of preferential exchange rates, with assistance reaching consumers through insurance under the Daruyar framework. Food and Drug Administration officials have cautioned against interpreting changes affecting certain production inputs as an immediate withdrawal of subsidized currency throughout the sector. The practical question is whether insurers can reliably deliver the protection reform requires.
Pensioners’ representatives are already questioning that reliability. Ali-Akbar Eivazi, secretary of Tehran province’s Social Security pensioners’ association, has described medicine prices and access as major difficulties for insured families. His criticism concerns Social Security, a separate insurer from the Health Insurance Organization. An adjustment in one system does not establish equivalent protection in another.
Pharmacies face another difficulty even after coverage is approved: collecting payment. In a September 5 statement, the Iranian Pharmacists Association said Health Insurance’s debts to private pharmacies stretched back ten months and urged the government to prioritize pharmaceutical funding. Pharmacies awaiting reimbursement must continue financing replacement stock. Rising prices make that gap harder to sustain.
The evidence points to a cumulative squeeze: currency instability raises financing pressures, the blockade complicates supply, and domestic payment delays undermine patient protection. Alternative routes need dependable funding, while expanded coverage requires timely reimbursement. Iranian authorities remain responsible for coordinating price changes and paying obligations. For families, the measure of success as external restrictions continue is whether the next prescription is both available and affordable.