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