While Iran produces most of the medicine its population consumes, the ingredients, the hard currency to buy them and the ships and planes that carry them all come from abroad. Successive rounds of war with Israel and the US over recent years and now a US naval blockade alongside a widening sanctions campaign are squeezing all three at once.
The result is an acute pharmaceutical shortage that Iranian officials have said is easing. Despite this, pharmacists have increasingly complained that the scarcity runs far wider than the official count. Reports in Iranian media also suggest that the price of some common drugs has multiplied severalfold over the last year. Patients who depend on insulin, cancer treatments and vaccines are among the most exposed to the crisis.
What seems to set the current crisis apart from previous shortages is that the fallback routes are narrowing too. Medical cargo that previously arrived by sea has shifted to air, and Washington has now sanctioned Iran's airline sector. With subsidized foreign currency for medicine importers also being cut, the cost of keeping pharmacies stocked is moving from the state to drug makers, with Iranian patients bearing the brunt.
Counting the gaps
Iranian pharmacists have been sounding the alarm over critical shortages since late August. Shahram Kalantari, head of the Iranian Pharmacists Association, reported at an Aug. 26 press conference that about 70 vital medicines were short out of about 3,000 formulations. Around 400 products were hard to find, he added, or about 800 once specific brands are counted.
By contrast, weeks later officials began describing a crisis that was easing. Health Minister Mohammad Reza Zafarghandi told a government meeting on Sept. 14 that prior to the Feb. 28 Israeli-US strikes on Iran, 63 essential medicines were in short supply, with 43 midway through the fighting before an April ceasefire, and 32 at the time of the meeting. Mehdi Pirsalehi, the deputy health minister who heads Iran's Food and Drug Administration (FDA), said at a Sept. 15 press conference that shortages of essential medicines were at a low.
The two counts appear to measure different things. The ministry's figures track shortages on its list of essential medicines, while Kalantari's tally covers what pharmacies cannot supply across some 3,000 formulations. Even the 70 or so vital medicines he listed are more than twice the 32 the minister cited nearly three weeks later. By the ministry's count the shortage is shrinking, while the pharmacists' wider count describes a far larger one.
Kalantari put the pharmacies' shortages down to money rather than the war itself, citing a lack of liquidity, with insurers owing pharmacies some 770T IRR (282.8M USD). The war has nonetheless damaged production directly. Israeli-US strikes on Mar. 31 hit Tofigh Daru, a large Tehran maker of anesthetics and cancer drugs, the Iranian government said. The firm was among several pharmaceutical plants reportedly struck during the war.
From sea to sky
The US naval blockade of Iranian ports, imposed in April and only briefly lifted since, has cut into the seaborne pharmaceutical import route. With shipping through the Strait of Hormuz also disrupted, importers have turned to air and land routes that carry less and cost more.
India, one of the countries Iran buys pharmaceutical raw materials from, has become a point of public dispute in Tehran. In remarks carried by Euronews Persian on Aug. 11, Zafarghandi said India had not sent a single shipload of pharmaceutical ingredients during the war and had made deliveries conditional on Indian vessels being allowed through Hormuz.
Pirsalehi offered a different account the same day. India's cooperation had been notable, the FDA chief said in comments published by Nournews, and the main obstacles were the lack of a direct land route, the blockade and refusals to accept Iranian flights on some routes.
However the cargo travels, freight has become far costlier. A ship can carry several thousand tons of raw materials while an aircraft takes 40 tons at most, Zafarghandi noted in the same report. On Sept. 14, Zafarghandi put the rise in transport costs at tenfold as cargo shifted to aircraft. Pirsalehi stated on Aug. 16 that the cost of shipping a container from China or India, about 2,000-3,000 USD before the war, had at times reached some 30,000 USD.
Air freight is now under pressure too. On Aug. 24, the US Treasury launched 'Operation Economic Outcast', describing it as "an unprecedented, whole-of-government, economic campaign" against Iran. On Sept. 8, the department sanctioned 27 Iranian airlines and suspended authorizations that had allowed foreign carriers to fly US-origin aircraft into Iran.
The timing matters because medicine already depended on air cargo far more than other goods. Customs data cited on Sept. 17 by the London-based think tank Bourse & Bazaar show that slightly more than 60% of Iran's medical imports arrive by air, against 8.4% of imports overall.
The same data show that more than 30% of the medical cargo passing through Tehran's Imam Khomeini International Airport in the 10 months to Feb. 2026 was hormone medicines, a category that includes insulin and some cancer treatments, while vaccines accounted for slightly more than 10% and blood products for 6%.
US sanctions do not formally target medicine. Standing US Treasury guidance from 2020 states that those selling food, medicine or medical devices to Iran "will not be subject to sanctions" under the executive order now used against the airlines. Yet in practice, banking restrictions can stop Iranian companies from buying drugs and raw materials abroad even where the trade is formally legal, Euronews reported on Sept. 11. The airline measures now constrain the planes too.
Who foots the bill
Tehran has long shielded medicine prices by selling importers foreign currency at a subsidized rate. That cushion is shrinking. Pirsalehi told the same Sept. 15 press conference that the allocation for medicine and medical equipment had fallen from about 3.5B USD in the last Iranian year to 3B USD in the current budget, down about 14%. A further 400M USD has been withdrawn since the year began in March, at his own agency's proposal, leaving the sector with about 900M USD less in subsidized currency.
The dollars that drug makers buy outside that scheme have become dearer too. Iranian companies obtained about 1.5B USD last year at 600,000-700,000 IRR to the dollar, Pirsalehi said, and that rate has since reached about 1.7M IRR, up roughly 140-180%.
For raw materials moved off the subsidized rate onto the second tier of Iran's official currency exchange, the cost of a dollar has jumped from 285,000 IRR to about 1.6M IRR, up about 460%, Hadi Ahmadi, spokesman of the Iranian Pharmacists Association, noted in remarks reported by the Amsterdam-based, independent Persian-language outlet Radio Zamaneh on Sept. 13. That rate is still well below the open market's.
At the pharmacy counter, a price check published by Mehr News Agency on Sept. 4 found that acetaminophen-codeine had risen in a year from 1.37M IRR to 6.5M IRR (2.39 USD), up 374%, and amoxicillin from 3.2M IRR to 12.3M IRR (4.52 USD), up 284%. Insulin, which many diabetic patients need daily, has in some cases reached six times last year's price, according to the same Sept. 11 Euronews report.
Patients who cannot switch to another brand bear the greatest risk. "Advanced therapies are especially vulnerable to sanctions barriers," the Bourse & Bazaar report noted, since a few specialist manufacturers make them for small numbers of patients.
This season's influenza vaccine shows how late orders and blocked payments can keep a product out. Ahmadi explained to the daily Farhikhtegan on Sept. 6 that orders must be placed about eight months ahead and were not placed in time, and that a bank in Europe which handled the transfers had stopped processing them about six months earlier.
Iranian authorities are trying to secure more inputs at home. A trial crop of oleifera, a poppy variety, on nearly 10 hectares of state land, announced on Aug. 29 by Deputy Agriculture Minister Mohammad-Mehdi Boroumandi, is meant to yield the morphine that drug makers have so far drawn mainly from narcotics seizures. But as long as shipping, flights and payments remain constrained together, the cost of this crisis will likely be felt less on company balance sheets than in pharmacies and in patients' daily lives.