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Table 1 Strategies to increase the pharmaceutical supply chain resilience to sanctions

From: Strategies to improve pharmaceutical supply chain resilience under politico-economic sanctions: the case of Iran

Main themes Subthemes Final codes
Health policy and management Revisions in Iran’s health management Ban the importation of drugs that can be produced domestically
Elimination of the pharmaceutical mafia in the Ministry of Health
Consideration of health economics
Planning for funding and transportation of funds
Improving the resilience of the pharmaceutical system and preparing appropriate plans
More attention to the efficiency of the system
Reducing the authorization to establish pharmacies and clinics to prevent induced demand
Increasing and strengthening oversight Incorporating information and monitoring systems into a health problem
Increasing the efficiency of control instruments for pharmacies and clinics
Harmonization of control instruments in medical universities
Rapid detection of corruption and precise and targeted fight against it
Prevention of prescriptions against the pharmacopeia
Control with the aim of improvement and not punishment
Provision of clinical guidelines Considering clinical guidelines as a lost chain in Iran
Considering clinical guidelines as a tool for treatment management
Customizing consideration of clinical guidelines according to local needs
Delegation and privatization Delegation to medical universities by the Ministry of Health
Strengthening the authority of the private sector and pharmacists
Decentralization
Outsourcing of hospital pharmacies
Privatization of services
Centralized and strategic purchasing Use of centralized and pooled procurement to get great deals
Need for information transparency with pooled and centralized purchasing
Separation of purchaser and observer
Private or semi-public holdings
Separation of pharmaceutical accounts from other accounts
Separate payment for different entities
Proper implementation of the GP plan and referral system Existing government for patient health management
Correction of the primary care physician and referral system
Prevention of patient perplexity in choosing doctor and medications
Existing systematic relationship between the referral system and the food and drug authority
Utilization of potentials and infrastructure in Iran Strengthening of inter-sectoral cooperation National tender for the production of medical devices
Use of military facilities to manufacture medical devices
Creation of relationships between the medical industry, the Department of Defense, the electronics industry, and universities
Allocating contracts to universities to manufacture pharmaceuticals according to their potentials
More attention to mass media The crucial role of the media in improving the situation under sanctions and bringing peace to the society
The positive role of the media in society justification and decreasing crises
Improving public relations in medical universities in the field of pharmaceuticals
Creating a free space for information flow and preventing political favoritism
The crucial role of the media in increasing politicians’ accountability
Accurate news reporting to increase public confidence
Use of competent advisors to health managers in the media field
Relying on national and religious power and authority Improving religious and patriotic passions and enthusiasm
Improvement of sympathy and empathy in society
Use of social and human capital
Improving people's self-assessment
Relations with other countries Interactions with neighboring countries Planning to take advantage of neighbors
Increasing cooperation with Islamic countries and the Middle East
Increasing cooperation with Islamic countries and the Middle East
Formation of joint funds between Islamic countries for pharmaceuticals
Management and development of health tourism Determining the management of health tourism
Reducing the power of brokers in the field of health tourism
Receiving patients' bills in the form of international currencies
Reducing the problems related to visas for health tourism
Bringing needed medicines and medical devices by health tourists
Sale of equipment at its real price (without additional costs) to health tourists
Pricing processes Increasing expenditure on domestic medicine Increase in the price of medicines and medical equipment together with the increase in the currency
Addressing price instability
Increase in the price of cheap medicines
Continuation of the plan of branded generics and increase in the price of domestic products up to 50% of the cost of their branded counterparts
Rationalization of the prices of medicines Reducing import and increasing production through rational pricing of medicines
Consideration of transportation costs in pricing
Elimination of counterfeiting through real pricing
Change in the pharmaceutical price according to the value of major international currencies
Management of insurance organizations Strengthening the insurance system Payment of the pharmaceutical subsidies to insurance organizations
Insurance coverage to cover pharmaceutical price increase
Complimentary insurance role for those in higher percentiles
Crossover subsidiary
Mandatory insurance for all people
Removal of unnecessary medications from the list of insurance benefits Removal of luxury and cosmetic drugs from basic coverage
Increasing coverage for generic and low-cost brands
Elimination of brands for which generic alternatives exist
Revising the basic benefits package
Revising the basic benefits package
Transforming insurance into an industry Research by insurance organizations on ways to reduce drug costs
Cost-effectiveness research on pharmaceuticals
Control of insurance companies over the way medicines are consumed
Pricing and monitoring the funds
Changes in insurance methods
Integrated health information system Electronic health record Integration of health information systems
Use of the health care system to reduce the financial burden
Definition of services and drugs in the integrated system
Preparing facilities for the introduction of the smart health card
Electronic prescription Electronic prescribing to reduce treatment burden
Electronic facilities in rural areas for the development of electronic prescribing
Electronic prescribing as a tool to control prescribing
Defining a system to select the best drugs according to the cost and symptoms of a disease
Mechanization of the distribution system Medication tracking Tracking of medicines from distribution to consumption
Online relationship between MOH and distributors and importers
Design of a mechanized system for prescribing
Channelized distribution through a digital system
Control and monitoring of pharmacies and distributors Prevention of hoarding of medicines in pharmacies
Prevention of the over-the-counter sale of medicines in pharmacies
Reduction in the number of brokers in the distribution system
Reduction in the number of distributors
Correct planning for daily exclusion of medicines from distribution companies
Role of suppliers and manufacturers Provision of high-quality medicines Increasing the quality of domestic drugs and medical devices
More attention to the quality of domestic supplements
In vivo and in vitro evaluation of drugs by the government
Evaluation of the source substance of medicines by the MOH
Improving the quality of domestic production through interaction between manufacturers, prescribers, and consumers
Increasing the warranty of domestic products
Increasing production and exports More planning to increase domestic products
Production of medicines and medical devices for domestic use and export
Attention to the export of high-tech drugs and generics
Financing the provision of the initial substance through the development of drug export
Profitability through large-scale drug production
Role of the medical community and consumers Informing the medical community Increasing the knowledge of the medical community about domestic products
Increasing physicians’ and pharmacists’ knowledge about the costs and combinations of medicines
Strengthening the relation between pharmacies and the physicians
Physician access to the software containing drug lists, costs, and indication for prescribing
Raising physician awareness of the national pharmacopeia
Developing a culture of rational use of medicines and prohibiting self-medication
Emphasizing traditional Iranian medicine
Prohibition of prescribing non-indicated and expensive medicines
Use of alternative medicines and methods Use of simple and effective pharmaceutical protocols
Not using the most sophisticated methods for all cases
Justification and encouragement of patients to use alternative medicines
Substitution of monopolistic drugs by others
Determining the alternatives of 1,2,3 of treatment
Attention to the treatment priorities and collaborative decision making
Role of providers regarding lack of brand loyalty Less attention to international brands
Greater oversight over the prescription of branded drugs
Prescribers’ lack of vested interest in recommending a certain manufacturer’s products
Improving medical ethics to limit branding
Providers’ and prescribers’ positive attitude towards domestic drugs
Consumer–patient collaboration Rational prescribing of medications
Improving patients' culture and knowledge about medication use
Encouraging patients to use domestic medicines