Document Type : Original Article
Authors
1
,MA in Health Care Management Anesthesiologist in Shahid Modares Hospital
2
Associate Professor, Department of Health Care Management, Islamic Azad University, Tehran Medical
3
Professor, Department of Health Services Management, North Tehran Branch, Islamic Azad University
10.22034/qjo.2026.498447.1400
Abstract
Purpose:Non-communicable diseases, particularly diabetes and hypertension, account for a substantial share of the disease burden and healthcare costs in Iran. To control pharmaceutical expenditures and improve patients’ access to essential medicines, the national “Daroyar” reform plan was implemented in 2021. This study aimed to evaluate the impact of Daroyar on drug utilization patterns and pharmaceutical expenditures among patients with diabetes and hypertension in selected hospitals affiliated with Shahid Beheshti University of Medical Sciences.
Method: This cross-sectional study was conducted between 2021 and 2024. Data were collected from two sources: (1) patients’ medical records to extract information on the number of prescribed items, type of drugs (generic/brand), total pharmaceutical costs, and out-of-pocket (OOP) payments; and (2) a researcher-designed questionnaire assessing drug accessibility, adherence to treatment, satisfaction with insurance coverage, and attitudes toward generic substitution. Content validity was confirmed by an expert panel, and reliability was established with Cronbach’s alpha (α = 0.83). Data were analyzed using paired t-test, repeated measures ANOVA, and chi-square test in SPSS version 26.
Findings: After implementing Daroyar, the mean number of prescribed items
decreased from 4.7 to 3.9 (p<0.01), the share of generic medicines increased from
58% to 74% (p<0.001), the average monthly pharmaceutical cost declined from 1,250,000 IRR to 830,000 IRR (p<0.01), and the patients’ OOP share reduced from 43% to 29% (p<0.001). Among diabetic patients, reduced costs were mainly attributed to the replacement of branded insulins with domestic generics and increased use of metformin. In hypertensive patients, cost reduction was largely due to substitution of imported antihypertensives with Iranian generics. Despite these improvements, 46% of patients still reported difficulties in accessing medicines, and 39% expressed concerns about the quality and effectiveness of generic alternatives.
Conclusion: The Daroyar plan has significantly reduced pharmaceutical expenditures and promoted the use of generic medicines among patients with diabetes and hypertension. Nevertheless, challenges such as treatment discontinuation, limited satisfaction with insurance performance, and resistance to generic substitution remain. Strengthening patient education, enhancing targeted financial support, and ensuring strict quality monitoring of generics are essential to maximize the long-term effectiveness of this policy.
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