Iran International
Rising drug prices and lagging insurance coverage are pushing diabetes medication further out of reach in Iran, documents obtained by Iran International show, with one patient’s NovoMix FlexPen insulin payment rising more than 24-fold in less than two months.
The patient paid 1,592,500 rials (about $0.91) for 15 insulin pens in early May. The same prescription, purchased from the same pharmacy in Tabriz on June 28, cost 39,092,500 rials (about $22.27), an increase of about 2,355%.
The sharp rise in the patient's bill far exceeded the increase in the price of the medicine itself. The total cost of the prescription rose from 96,862,500 rials (about $55.19) to 134,362,500 rials (about $76.56), an increase of 37,500,000 rials (about $21.37), or about 38.7%.
The receipts show the same billing categories, including the insurer's contribution, the patient's share, coverage for patients with special illnesses and pharmacy service fees. But while the drug's price increased, the Social Security Organization's reimbursement remained fixed at 96,000,000 rials (about $54.70), leaving the patient to pay the difference.
The newer receipt also included a new line item labeled "difference" worth 37,500,000 rials (about $21.37), transferring the additional cost directly to the patient. That line did not appear on the receipt issued in early May.
As a result, while the price of the drug itself increased by less than 40%, the patient's out-of-pocket payment rose more than 24-fold because the insurance reimbursement ceiling was not adjusted.
Drug prices continue to climb
Iran International reported in late April that insulin prices had already surged compared with levels before the Persian New Year (March 21), with some domestically produced brands rising by up to 212% and imported products by as much as 271%.
The latest receipts suggest prices have continued to rise since then, while also highlighting the growing burden on patients as insurance coverage has failed to keep pace with higher costs.
Industry blames production costs
Pharmaceutical industry representatives say the crisis has been driven by a combination of factors, including the removal of subsidized exchange rates, the depreciation of the rial, higher prices for raw materials and packaging, rising wages, increased financing costs and supply chain disruptions linked to the recent war.
They say manufacturers have also struggled with higher working capital requirements, while delayed price adjustments and insufficient government and banking support have compounded the problem.
Since January, following the government's exchange-rate unification policy, pharmaceutical raw materials that had previously been imported at a subsidized exchange rate have instead been purchased at rates more than five times higher.
Mohammad Abdehzadeh, head of the Health Economy Commission at the Tehran Chamber of Commerce, told Donya-ye Eqhtesad on Wednesday that most medicines had been removed from the subsidized currency system since March and were now being produced using the new exchange rate.
The newspaper said Iran's pharmaceutical sector was facing twin pressures: producers struggling with sharply higher manufacturing costs and liquidity shortages, and patients increasingly forced to bear a much larger share of medicine costs out of pocket.
Iran's Supreme Leader Mojtaba Khamenei plans to remove judiciary chief Gholam-Hossein Mohseni Eje'i at the end of his first five-year term and appoint a new figure to lead the judiciary, sources familiar with the matter told Iran International.
Sources inside Iran told Iran International that Khamenei does not intend to extend Eje'i’s term for another five years, breaking with a practice followed for nearly four decades in which judiciary chiefs have usually served two consecutive five-year terms.
The sources, who spoke on condition of anonymity, said the decision is not aimed at judicial reform but is part of a broader reshaping of power after the recent war.
They said the new supreme leader is seeking to replace key officials in major state institutions with figures more closely aligned with him.
Eje'i’s expected removal could mark one of the first major signs of Khamenei’s effort to rebuild control over the Islamic Republic’s judicial, security and political apparatus after the transfer of power.
Hardliners step up pressure on Eje'i
The decision comes amid growing criticism of Eje'i from hardline figures after the names of Supreme National Security Council members who voted in favor of a memorandum of understanding with the United States were disclosed.
Critics say Eje'i’s vote was at odds with Khamenei’s stated position, after the leader said in a letter that he had, in principle, held a different view on the memorandum of understanding.
Signs of dissatisfaction with Eje'i’s five-year record have also appeared in recent official and semi-official commentary close to the power structure.
In a message marking Judiciary Week, Khamenei did not clearly endorse Eje'i’s continuation in office. Instead, he addressed the judiciary as an institution and called for the “actualization” of demands previously made by former Supreme Leader Ali Khamenei.
The message repeated calls for the implementation of the judicial transformation document, fighting corruption inside the judiciary, reviving public rights, blocking the use of recommendations and lobbying, and improving communication with the public.
Eje'i seeks to defend his record
A day later, Eje'i published a letter to Khamenei in deferential language, defending the judiciary’s performance and pledging to continue the path of “judicial transformation.”
“I and all components of the judiciary consider ourselves obliged to carry out Your Excellency’s binding commands precisely, swiftly and without any reduction,” Eje'i wrote.
Media outlets and figures close to the establishment criticized Eje'i for not publishing such a letter before Khamenei’s message. Some also described the new leader’s renewed emphasis on his father’s demands as a negative assessment of Eje'i’s record, arguing that their repetition showed the judiciary had failed to deliver practical results under him.
Rival factions inside the establishment have also stepped up attacks on Eje'i, accusing him of distancing himself from the leadership’s demands.
Media close to Parliament Speaker Mohammad Bagher Ghalibaf and President Masoud Pezeshkian have described the attacks as part of an effort by the faction aligned with Saeed Jalili, a member of Iran’s Supreme National Security Council, and the Paydari Front to create divisions among senior officials and weaken the postwar political path.
Media close to the judiciary and Eje'i’s supporters have sought to portray his five-year record as successful, citing reduced imprisonment, electronic court proceedings, shorter trials, anti-corruption efforts and public outreach.
Rights groups point to record of repression
Human rights groups and activists say Eje'i is not a reformist figure but a long-standing part of the Islamic Republic’s repressive judicial and security apparatus.
They point to his record in the Special Clerical Court, the Ministry of Intelligence, and later as first deputy and head of the judiciary, saying his tenure has been marked by continued heavy sentences against protesters, political activists, journalists, prisoners of conscience and minorities.
Rights advocates say the judiciary under Eje'i has continued to act as the legal and executive arm of security institutions in political and security cases.
They also argue that replacing Eje'i alone would not bring meaningful change without structural reform, an end to security interference in judicial cases, guaranteed access to lawyers, a halt to forced confessions, the annulment of political verdicts and respect for fair trial standards.
