Spiraling health costs force Iranians to delay care

A 70-year-old woman with advanced breast cancer was supposed to undergo chemotherapy every two weeks. Doctors had scheduled six treatment sessions, each costing around 100 million Iranian tomans (about $530 or €450).

Iran's minimum monthly wage for workers covered by the country's labor law is 16.6 million tomans, meaning that just one of her chemotherapy sessions costs roughly six times the monthly minimum wage.

The woman's children asked her doctor to postpone the next round of treatment while they searched for a loan or any other source of financial support, according to colleagues of Hamid Hemmatpour, an Iranian physician based in Austria and a member of the executive board of the Association of Healthcare Professionals for Human Rights-Austria.

Her story is far from unique. Across Iran, rising prices, persistent shortages, disruptions in foreign currency transfers and growing pressure on the health care system are making access to treatment increasingly difficult, according to Hemmatpour and another Iranian physician based in Austria, Hassan Nayeb Hashem.

Drug prices rise sharply in Iran

In one example, an Iranian pharmaceutical company recently announced price increases for 82 products.

The average price of those medicines rose from roughly 180,000 tomans to 390,000 tomans, an increase of around 120%, according to figures published by Tasnim News Agency, which is affiliated with Iran's Islamic Revolutionary Guard Corps.

The list shows particularly steep increases for a number of medicines. Donepezil rose by about 543%, clarithromycin by roughly 308%, and amoxicillin by around 115%. The prices for some acetaminophen and diphenhydramine syrups increased by about 135%.

The figures relate to a single manufacturer, but they illustrate the scale of the financial pressure many patients face.

Insulin users are among those hardest hit. Hemmatpour said the cost of a monthly prescription of four NovoRapid insulin pens has risen from about 280,000 tomans after insurance reimbursement to roughly 1.1 million tomans.

When patients delay treatment

Hassan Nayeb Hashem warns that shrinking access to vital treatments could have tragic consequences.

"If the medicine becomes inaccessible, patients can develop complications much sooner," he told DW. "The most serious risk is premature death."

In many cases, switching medications is not a practical solution.

"For many specific diseases, there is effectively no substitute," he added.

Cancer patients are particularly vulnerable because treatment schedules are often tightly structured. Delays can reduce the effectiveness of therapy and affect outcomes.

Hamid Hemmatpour says some patients ask physicians abroad to obtain cancer medicines, while others postpone or abandon treatment after learning the cost.

The cancer drug Keytruda (pembrolizumab) is one example. An Iranian-produced version can cost around 70 million tomans, more than four times the monthly minimum wage, according to Hemmatpour. Imported Indian versions may sell for around 300 million tomans, European versions can cost even more.

Not surprisingly, experts report rising demand for medicines obtained through unofficial cross-border channels.

"The question is under what conditions these medicines were transported," Hemmatpour said. "Some of these drugs require refrigerated transport. Patients often have no way of knowing whether proper storage conditions were maintained during the journey."

Hemmatpour and Nayeb Hashem also warn that imported drugs may be counterfeit or expired, potentially reducing their effectiveness and posing additional health risks.

Why medicine shortages persist in Iran

Many of the country's health challenges predate the current war. Iran's pharmaceutical industry had already been struggling with a weakening currency, rising production costs and delayed payments from insurers.

US sanctions added another layer of difficulty. Medicines and humanitarian goods are generally exempt from sanctions, but restrictions on banking transactions and international payments can complicate pharmaceutical trade.

Iranian officials have attributed part of the current shortage to a disruption of supply chains and difficulties in transferring foreign currency.

Mehdi Pirsalehi, head of Iran's Food and Drug Administration, has said money transfers slowed dramatically after the war began, nearly coming to a standstill for one to two months and continuing at a reduced pace for several months afterward.

At the same time, Abdolnaser Hemmati, governor of the Central Bank of Iran, says the amount of foreign currency allocated for medicines and medical equipment during the first five months of the current Iranian year was 30% higher than the same period a year earlier.

The statements suggest the problem extends beyond the amount of foreign currency allocated. Delays in payments, imports, manufacturing or distribution can all contribute to shortages.

Why Iran faces a deeper medicine crisis

Medicine shortages are not unique to Iran. In recent years, countries including Germany and the United States have also faced shortages of antibiotics, cancer therapies and other essential medicines, partly because of manufacturing problems and vulnerabilities within global supply chains made especially clear by the COVID-19 pandemic.

Iran's situation is particularly difficult as it finds itself facing the brunt of several pressures at the same time.

Currency depreciation, rising production costs, pressure on insurers, sanctions-related obstacles and the economic consequences of war have all converged on a health care system that was already weak.

Salman Eshaghi, spokesman for the Health and Treatment Committee of Iran's parliament, says around 43 medicines are currently classified as being in "critical shortage," while nearly 1,000 pharmaceutical products face some degree of shortage.

He says higher prices for medicines used to treat cancer, hemophilia and thalassemia have already caused some patients to reduce treatment or stop it altogether.

Originally, patients were expected to pay about 30% of health care costs, with insurers and the government covering the rest, according to Eshaghi. But now patients are paying more than 70% out of pocket.

For the 70-year-old woman with breast cancer, however, the broader debates and international wrangling do not alter her predicament.

Her doctor recommended treatment and her family wanted her to continue, but they simply could not afford the next chemotherapy session. It remains postponed while her children hunt for a way to pay for it.

Edited by: Tim Rooks