Table 1 Emerged themes, subthemes, and codes related to drivers of vulnerability to medicine smuggling in Iran
Theme | Sub-theme | Drivers of vulnerability to smuggling | Combat strategies |
|---|---|---|---|
Economic environment | Medicine selection and reimbursement | • Unrealistic prices of locally manufactured medicines • Defective pharmaceutical pricing mechanism • Multiple exchange rates • Financial incentives of the pharmaceutical market • Liquidity problem of the pharmaceutical industry • Insurers’ debt to pharmacies | • Pricing mechanisms reform • Strengthening and capacity building of health insurance • Exchange policies reform • Reforming pharmaceutical exchange policies |
Medicine procurement | • Increased black market • Imposition of economic sanctions | • Financial and knowledge-oriented support of the pharmaceutical industry • Improving the banking system | |
Governance and stewardship | Targeted supervision and control | • Weak intersectoral collaboration • Low authority of the Ministry of Health • Black-market distributors • Physicians’ preference to prescribe brand medications • No adherence to clinical guidelines • Increased induced demand • Poor border control • Collusion and bribery by executive staff/officer | • Strengthening control of borders • Strengthening inter-sectoral/ agency collaboration • Improved intelligent and digital monitoring systems • Developed and institutionalized administrative health audit initiative |
Directive strategies and policies | • Shortcomings in the pharmaceutical supply and distribution chain • Insufficient supervisory manpower • Inefficient pharmaceutical subsidy policy | • Imposition of duties or tariffs for the subsidized goods • Outsourcing of supervision of pharmacies | |
Legislation and regulation | • Outdated and old-fashioned anti-trafficking/smuggling laws • Conflict of interests in the pharmaceutical system • Low political will | • Inquiring about the authenticity of pharmaceutical products • Updated and deterrent laws and penalties • Prohibition of prescribing medicines out of the Pharmacopoeia list • Identification of health-oriented products with a unique code | |
Information technology systems | Electronic pharmaceutical information systems | • Shortcomings of the electronic prescription scheme • Flaws in TTAC* and its security vulnerabilities • Lack of electronic infrastructure in the pharmacy • Lack of linkage with the electronic information systems of other organizations • Lack of linkage between the TTAC system and electronic prescription systems | • Electronic prescription systems • Using the capacity of electronic health records • To link between fragmented pharmaceutical information systems • Fixing of software and system bugs |
Socio-cultural factors | Awareness raising of patients and providers | • Poor cultural persuasion of patients and providers • Poor dissemination of accurate/clear information • Irrational medication use • Poor public awareness about smuggling | • Public awareness about the consequences of illicit medicine smuggling • Public awareness about the TTAC system • Eliminating the motivation for smuggling by destroying discovered smuggled medicines |