Impact of Delisting Non-Prescription Medicines from Health Insurance Coverage on Physicians' Prescribing Behaviour in Iran: A Qualitative Study.

Objective: In June 2018, Iran's national health insurance policy excluded coverage for 79 nonprescription medicines (NPM) for outpatients aged over 12 years. Since physicians play a crucial role in healthcare delivery, this qualitative study explored how the delisting of NPM influenced their prescribing behavior and their perceptions of the policy. Methods: Semi-structured face-to-face interviews were conducted with 22 physicians (16 general practitioners, 4 gynecologists, and 2 internists) from two socioeconomic areas in Tehran between June 2019 and March 2020. Thematic saturation was achieved after 17 interviews, with 5 additional interviews for validation. Data were analyzed using Braun and Clark's thematic analysis, with Lincoln and Guba's criteria ensuring trustworthiness. Findings: Six key themes emerged: knowledge about NPM, insurance role, information gap, financial aspects, prescribing patterns, and patient responses. Physicians perceived NPM as affordable, safe, and difficult to replace. Some reported insufficient knowledge about alternative medications and their insurance coverage. Barriers to altering prescribing habits included the therapeutic advantage of NPM and the preference for clinical need over insurance. Most physicians viewed the policy as irresponsible, increasing the financial burden on low-income patients and even encouraging self-medication. Conclusion: Delisting of NPM did not significantly impact physicians' prescribing behavior during the study period. While these findings indicate physicians' concern, further quantitative studies are required to ascertain the long-term impacts of such a policy on rational drug use, healthcare expenses, and outcomes for patients in Iran.