گزارش‌ها و مصاحبه‌های روشنگرانه فرهنگی، اجتماعی، اقتصادی
بحران دارو در ایران

Behind the scenes of the “medicine crisis” in Iran

“Life is in the hands of God.” This statement by Ebrahim Raisi was made in the presence of patients with special needs. There is no doubt that life is in God’s hands, but it seems that Mr. President and his close associates have not searched pharmacies for medications for these special diseases. The suffering and pain of illness is one side of the story, but the inability to find medication adds a second layer of suffering.

The increase in drug prices and shortages is becoming a serious crisis. The price of medications for special diseases, especially cancer treatments, has multiplied in recent times. The government has officially announced that there is a shortage of about 300 types of medications, while non-governmental sectors claim this figure is 600.

The issue of medication is no longer something trivial like meat and chicken that an expert on state television can simply say, “Don’t eat it!” Medication is connected to human health and life, and having access to it is essential; without it, many of our loved ones may be lost.

In this drug crisis, it’s not just the people who are affected; even the owners of these industries are suffering and going bankrupt. In existing reports, pharmaceutical industry owners have repeatedly warned that they are on the brink of bankruptcy.

But why has this drug crisis arisen? To answer this question, we must return to the 2021 elections and Raisi’s promise to “reduce healthcare costs by 50%.” However, when the government took office, not only was this promise not fulfilled, but the “Jahangiri currency,” or the fixed exchange rate of 4200 tomans, was also eliminated and replaced with the floating exchange rate. The floating exchange rate was 28,000 tomans last year and is now 42,000 tomans. Therefore, it is not surprising that we are facing a multiple increase in drug prices, which contradicts Ebrahim Raisi’s election promise.

The government instructed pharmaceutical companies not to raise prices, which is a form of price control. For example, consider a pallet that a pharmaceutical company intends to import, costing one million dollars. At the fixed exchange rate of 4200 tomans, this pallet would cost 4 billion and 200 million tomans. With the removal of the fixed rate and its replacement with the floating rate, the price of this pallet has skyrocketed from 4 billion and 200 million to 42 billion tomans, yet the government still asks the pharmaceutical company not to raise prices.

To address this issue, the government initiated a plan called “Darouyar,” but interestingly, it did not last a year. The Minister of Health stated, “I am not responsible for the failure of the Darouyar plan!” In fact, a plan that had not yet started faced failure, disrupting the financial order of the drug supply chain. Previously, the government provided financial support or subsidies to maintain a reasonable drug price and prevent pressure on consumers, but in the Darouyar plan, the government eliminated the 4200 toman currency and stated that it would provide a subsidy to insurance companies at the end of the chain to distribute among pharmacies, claiming that this way, no money would be taken from the people’s pockets. However, this also did not materialize.

In Ordibehesht 1402 (May 2023), pharmacies had still not received payments owed to them for seven or eight months, resulting in serious liquidity issues for these pharmacies. They began dispensing medications for patients with special diseases, which are 90% covered by insurance, to patients at full price, without processing them through insurance. For example, a medication for cancer patients costs about 5 million tomans, and with insurance, the patient should only pay 500,000 tomans. However, pharmacies cannot wait for insurance to pay after nine months and tell the patient, “I will provide this medication at full price.” Thus, both the pharmacy and the patient face problems, and in this economic situation, people easily succumb to illness.

This issue acts like a domino effect, causing everyone to fall; insurance cannot pay pharmacies, pharmacies naturally cannot pay distribution companies, and distributors cannot pay the drug manufacturers. This has led to a serious drug crisis recently, and it seems there are no measures in place to address it.

Last year, the budget for the pharmaceutical industry was 70 trillion tomans. Due to inflation, this year’s budget was reduced to 65 trillion tomans, but after negotiations by industry activists, it was increased to 85 trillion tomans. However, we need 120 trillion tomans to secure medications in Iran, so where will this 35 trillion tomans come from? From the people’s pockets?!

Despite all this mismanagement, the government claims it supports domestic production and restricts imports. For example, last year, salbutamol spray, used for asthma patients and those with chronic obstructive pulmonary disease, became scarce because manufacturers were unable to obtain currency allocations to import the gas for the spray. To alleviate the shortage, the government expedited the process for this medication, but interestingly, it granted its own manufacturer a floating exchange rate of 28,000 tomans while providing the importer with the 4200 toman rate, and this spray was imported from India.

If we set aside the performance and shortcomings of the Minister of Health in negotiating for budget allocations, the Planning and Budget Organization and the Central Bank also play a crucial role in this crisis, as they do not provide the budget and currency needed for this industry. For months, the Central Bank has failed to pay the designated currency to drug suppliers, a cost that the people of this land are paying for with their lives.

 

 

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