Authors

• . Mehrnaz Kheirandish ¹
• . Arash Rashidian ²
• . Abbas Kebriaeezade ³
• . Abdol Majid Cheraghali ⁴
• . Fatemeh Soleymani ³

¹ Department of Pharmacoeconomics and Pharmaceutical Management, Tehran University of Medical Sciences, Tehran, Iran

² Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran Department of Global Health and Public Policy, Tehran University of Medical Sciences, Tehran, Iran

³ Department of Pharmacoeconomics and Pharmaceutical Management, Tehran University of Medical Sciences, Tehran, Iran Research Center for Pharmaceutical Management and Pharmacoeconomics, Tehran University of Medical Sciences, Tehran, Iran

⁴ Faculty of Pharmacy, University of Baqiyatallah Medical Sciences, Tehran, Iran

Abstract

An economic crisis has been defined as a situation in which the scale of a country’s economy 
becomes smaller in a period of time. Economic crises happen for various reasons, including 
economic sanctions. Economic crises in a country may affect national priorities for investment 
and expenditure and reduce available resources, and hence may affect the health care sector 
including access to medicines. We reviewed the pharmaceutical policies that the countries 
adopted in order to mitigate the potential negative effects on access to medicines. We 
reviewed published reports and articles after conducting a comprehensive search of the 
PubMed and the Google Scholar. After extracting relevant data from the identified articles, 
we used the World Health Organization (WHO) access to medicines framework as a 
guide for the categorization of the policies. We identified a total of 40 studies, of which 10 
reported the national pharmaceutical policies adopted to reduce the negative impacts of 
economic crises on access to medicines in high‑income and middle‑income countries. We 
identified 89 policies adopted in the 11 countries and categorized them into 12 distinct policy 
directions. Most of the policies focused on financial aspects of the pharmaceutical sector. 
In some cases, countries adopted policies that potentially had negative effects on access to 
medicines. Only Italy had adopted policies encompassing all four accesses to medicine factors 
recommended by the WHO. While the countries have adopted many seemingly effective 
policies, little evidence exists on the effectiveness of these policies to improve access to 
medicines at a time of an economic crisis.

Keywords

• Access to medicine
• economic or financial crisis
• economic sanction
•   pharmaceutical policy