ArticleJournal of research in pharmacy practice
From Markup to Value: Global Implications of Iran's Cost-plus Pharmaceutical Pricing for Emerging Markets.
Article in Journal of research in pharmacy practice. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: In many emerging economies, simple cost-plus markups push medicine prices far above reference benchmarks, undermining affordability and access. Iran exemplifies this problem, with a public sector median price ratio (MPR) of 6.70 - nearly seven times the reference price - and an out-of-pocket (OOP) burden exceeding 50%. This study aims to benchmark Iran's cost-plus pricing framework against international alternatives, quantify the independent effects of cost-plus dominance and inflation on relative prices, and model policy scenarios to reduce household spending. Methods: We compared eleven countries (high-income: Germany, France, UK; upper-middle-income: South Korea, China, Brazil, Turkey, South Africa, Thailand; lower-middle-income: Iran, India) using WHO/HAI surveys (2023) to derive public/private MPRs, OOP percentages, and availability metrics. An ordinary-least-squares regression of ln (MPR) on cost-plus dominance (binary), log GDP per capita, and consumer-price-index (CPI) inflation quantified key drivers. Scenario modeling for Iran estimated OOP impacts under (i) a 30% CPI-adjusted cap (MPR = 4.69) and (ii) an health-technology assessment (HTA)-linked value-based regime (MPR = 2.00). Findings: Iran's cost-plus system predicts a 178% higher MPR (β = 1.02; Conclusion: Static cost-plus pricing perpetuates catastrophic patient costs. Phased reforms - beginning with CPI-indexed ceilings and advancing to HTA-driven value pricing - can transform unaffordable systems into sustainable, equitable models for emerging markets.
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