Severe Medicine Shortages in Iran Expose the Vulnerable Amid US Sanctions and Economic Collapse

Iranians seeking medication from pharmacies are facing soaring prescription prices as US sanctions devastate the economy. When 35-year-old Sima walked into a Tehran pharmacy, her eyes raced across the shelves behind the counter, searching for the box that would keep her kidneys from failing. Without it, she was running out of time. She finally found the medication in the seventh pharmacy she visited, in a wealthy Tehran neighborhood. Her relief faded when the pharmacist told her that the price had once again gone up, leaving her with no choice but to underdose the lifesaving medication.

As US sanctions suffocate Iran’s economy, ordinary people with chronic conditions and serious illnesses are struggling to find the medicine they depend on to survive. With severe shortages and daily price increases, many, like Sima, have been forced to cut doses, postpone doctor visits or self-medicate. “They’ve stopped using cancer medication for people who they say are terminal or far along,” said Sima, who did not give CNN her real name so she could speak freely. “They only use it for those who are in the very early stages.”

A mother in Tehran who lost her only daughter has been forced to change her antidepressant medication to a less effective locally produced version. Seasonal flu vaccinations have been called off this year after the government failed to procure them from Europe. Cancer patients are selling their televisions and refrigerators to buy overpriced medication. A 55-year-old cancer patient, who asked to remain anonymous, said she, too, is running out of options. “I’ve asked if people who come visit or come back from abroad can bring my medicine back, especially the things we can’t find here or get access, too,” the patient, who lives in Tehran, told CNN. “Between the illness and uncertainty of the war I have a hard time knowing what to do.”

Pharmacies in Iran contacted by CNN confirmed shortages and price increases across several categories, including heart medication, which is now offered as a local generic rather than the prescribed brand, cholesterol-lowering pills, which are available but far more expensive, and migraine drugs, which have completely vanished from shop shelves. Iran media reports, however, suggest the shortages are far more wide-reaching, affecting everything from antidepressants to insulin and pregnancy medications. Other drugs are completely unobtainable, leaving Iran’s sick facing astronomically higher prices or a less effective generic version.

The shortages have affected almost 800 medications, the head of the Iranian Pharmacists Association Shahram Kalantari told a press conference last month, with pharmacies unable to procure alternatives due to the rising costs. “Everyone says we’re brave,” the cancer patient added in a telephone call. “But I don’t know if being brave means anything when you’re dying.”

Iran now manufactures more than 97% of its medicines by volume, Mehdi Pirsalehi, head of the country’s Food and Drug Organization, said in February. Hardest hit are imported specialty drugs that must be paid for in foreign currency. Shortages of these drugs have grown under US President Donald Trump’s maximum-pressure campaign, which has intensified scrutiny of Iran’s banks and impeded exports of oil – the main source of the foreign currency for the Islamic Republic.

“This high level of domestic production does not necessarily mean complete self-sufficiency,” said Peivand Bastani, Senior Lecturer at Flinders University and co-author of research examining the effects of sanctions on pharmaceutical procurement in Iran. “Local manufacturing can still depend on imported materials, equipment and technology, while some specialized and high-cost medicines must be imported.”

Pharmacies cannot replenish their inventories because insurance companies have stopped paying them, according to Iranian officials. With millions of Iranians covered by insurance, presenting an insured prescription at a pharmacy usually produces nothing, or requires the patient to pay out-of-pocket. Rampant inflation, the collapse of insurance payments, and the government’s inability to sell oil and obtain the foreign currency needed to repay pharmacies have fractured the supply chain. More than 18,000 private pharmacies across the country are now waiting to get paid by insurance companies, officials from Iran’s Pharmacists Association said at a news conference last month, with insurance debts owed to pharmacies reaching almost 800 trillion rials ($300 million).

US and Israeli airstrikes on Iran earlier this year damaged more than 40 pharmaceutical companies, equipment suppliers and distributors, the spokesman for Iran’s Food and Drug Administration, Mohammad Hashemi, told Iranian state-affiliated media in June. In late March, Israel struck the factory of a major Iranian pharmaceutical company, Tofigh Daru, which produced active ingredients for anticancer drugs and anesthetics. The Israeli military claimed the company provided fentanyl to an Iranian entity conducting “research and development of chemical weapons” – something the company denied. Airstrikes also damaged the historic Pasteur Institute, founded more than a century ago.

Last month, US Treasury Secretary Scott Bessent announced that the US would clamp down on the complex network built by Iran over years to allow its entities to evade Washington’s wide-ranging sanctions. Washington has permitted transactions involving humanitarian goods, but has added safeguards to prevent diversion. Experts say the laborious bureaucratic process and overcompliance by international banks have severely discouraged foreign firms from doing business with Iran, leaving patients to suffer the consequences.