بررسی پوشش بیمه‌ای دارو در ایران در مقایسه با کشورهای منتخب

Introduction: in Iran, the compilation council of drug, having an advisory role, is responsible to cover medicine costs for health insurances. Health Insurance High Council also acts as the final decision maker about the admission of new drugs. This article studies how new drugs in Iran's health insurances are covered compared with some selected countries.  Methods: After collecting drug acceptance criteria from studies in selected countries, the importance of these criteria were measured by Iran's health system experts by means of a questionnaire. The differences and the reimbursement mechanism were investigated using 30 drug samples.  Results: There are specialized organizations in selected countries that decide for the new obligations of basic health insurances based on clinical and economical aspects of medicine performance criteria directly or as an advisory arm. Health insurance companies usually contract conditionally to protect new drugs commitment with the drug manufacturing companies.  Conclusions: In spite of low health and economical indicators of Iran compared with the selected countries, acceptance and continuing to repay the cost of pharmaceuticals are not associated with the amount of performance and the effects of the drugs. The acceptance of 43 percentage of drug samples is conditional to being a domestic production, the organization's budget, low price and the disease epidemiology. 57% of the samples did not have any insurance coverage. The new drug reimbursement decisions in Iran's health insurance usually last a long time (at least seven years) after accepting the drug in insurance companies of advanced countries. Iranian base health insurance companies are not actively involved in drug pricing. They control most of the reimbursement costs of drug from the demand side instead of the supply side.