Policies to improve access to pharmaceutical products in shortage: the experience of Iran food and drug administration.

BACKGROUND: In the past decades, economic sanctions imposed on Iran for its nuclear program. The embargo made difficulty in foreign trade and led to lack of timely access to medicines. As the internationally-led sanctions caused to the shortage of medicine there, healthcare systems need to applied the new policies for maintaining health service quality especially in pharmaceutical sector. OBJECTIVES: This paper is about policies applied in Iran health system during the crisis reached its peak in 2012 as a good experience for guarantying access to pharmaceutical products. METHODS: Through interviewing experts and managers in pharmaceutical regulatory system, the implemented policies in targeted historical period were extracted, then quantitative data were analyzed to show the impact of the policies on the access and affordability of medicines before and after their implementation in Iran food and drug administration (IFDA). This paper tries to show strategies employed by to tackle the crisis caused by sanctions and to offer practical policies to make medicines more accessible at the time of crisis. RESULTS: In order to reduce the harmful effects of this crisis, IFDA proposed some changes at different levels ranging from organizational procedures to parliament legislations. The main achievements of IFDA were making drugs easily available are as follows, significantly reducing prices, decreasing the share of market regarding the imported medicines, facilitating the manufacture of domestic medicines, encouraging foreign investment in manufacturing drugs domestically, controlling the shortage of drugs, and finally giving financial support to all patients in general and to those patients who had problem paying for drugs in particular. CONCLUSION: These experiences which made the Iran pharmaceutical sector survive during the international sanctions, can be considered as a good example of resilience strategies in similar situations. Graphical abstract IFDA policies to improve access to pharmaceutical products in sanction.

The Impact of the Sanctions Made Against Iran on Availability to Asthma Medicines in Tehran.

The impact of the international sanctions on the Central Bank of Iran in 2013 and also accessibility of medicines in this country have received a lot of media coverage. In this study we used the data collected from a group of pharmacies all located in Tehran to assess the potential effects of the banking sanctions on access to asthma medicines. Data were collected from forty community pharmacies in Tehran, using a standard methodology proposed by the WHO and Health Action International. Data were collected in two stages: first before the sanctions were made against the banking system in the summer of 2012, and second after they were in effect in the summer of 2013, and they were analyzed using univariate analysis techniques. Several imported medicines were already in shortage during 2012. As a result of the sanctions, the availability of both imported and locally manufactured asthma medicines decreased by 19% and 42%, respectively. While before the height of the sanctions 60% of the pharmacies could provide all the essential asthma medicines, this number reduced to 28% after the sanctions (p-value: 0.003). While studies about "access to medicines" in Iran prior to 2011 were indicating appropriate access, our findings suggested that the availability of asthma medicines in community pharmacies was already less than ideal in 2012 and declined dramatically after the latest wave of the sanctions. Our findings show the important effects of the sanctions on availability of asthma medications in community pharmacies.

Comparison the analgesic effects of single dose administration of tramadol or piroxicam on postoperative pain after cesarean delivery.

A multimodal approach to postcesarean pain management may enhance analgesia and reduce side effects after surgery. We investigated postoperative pain in a double-blinded, randomized, single-dose comparison of the monoaminergic and mu-opioid agonist tramadol, 100 mg (Group T) and piroxicam 20 mg (Group P) given IM alone--single dose in 150 patients who had elective cesarean delivery. All patients were assessed at 0, 6, 12 and 24 hours post operation for pain degree (by Visual Analogue Score: VAS 1-10), nausea and vomiting. Pain degree was classified as: Painless: 0, Mild: 1-4, Moderate: 5-8, Severe: 9-10. There was no significant difference between the efficacy of tramadol and piroxicam injections (P > 0.05). Pain intensity decreased markedly over time in both groups. Mean +/- SEM pain degrees were as follows: P = 7.7 +/- 0.5, T = 8.2 +/- 0.8 after 0 hours; P=5.4 +/- 0.6, T = 6.1 +/- 0.5 after 6 hours; P=3.3 +/- 0.4, T = 3.4 +/- 0.7 after 12 hours; P = 1.1 +/- 0.4, T = 1.3 +/- 0.5 after 24 hours of surgery. Side effects were similarly minimal with all treatments. It might be concluded that i.m. injections of 20 mg piroxicam (single dose therapy) could relieve postoperative pain after cesarean section as well as tramadol and it could reduce opioid analgesic requirements with less adverse side effects during the first postoperative 24 h.