Three in ten Iranians forego medication as prices soar
Rising drug costs are putting essential medicines out of reach for many Iranians with three in ten leaving pharmacies without their medications, according to the Iranian Pharmacists Association.
Rising drug costs are putting essential medicines out of reach for many Iranians with three in ten leaving pharmacies without their medications, according to the Iranian Pharmacists Association.
“The increase in the price of certain medications has shocked the public, with three out of every ten people who enter a pharmacy choosing not to purchase their medication," said Hadi Ahmadi, a board member of the Iranian Pharmacists Association, on Sunday.
"Why should such a situation occur where people refuse to take their medication or cannot afford to buy it? Out-of-pocket expenses for outpatient treatments have risen and now exceed 50%."
Reports have highlighted the financial strain caused by medication price increases. According to Tasnim News Agency, medication costs have surged by up to 400% since the removal of subsidized foreign currency.
Labor union activists and retirees warn that these steep prices are putting essential treatments out of reach for many, including those at risk, as more than one third of Iran is now living below the poverty line.
Shahram Ghaffari, Deputy for Treatment at the Social Security Organization, said on Sunday that the Food and Drug Administration implemented the increases to address shortages and support producers.
However, he criticized the lack of coordination with insurance providers, which has left patients covering the full cost of the hikes.
"Prices were not updated in insurance systems," he explained, "resulting in significantly higher out-of-pocket costs."
President Masoud Pezeshkian’s 2025 budget reduces foreign currency allocations for essential goods by 20%, while increasing the subsidized exchange rate by 35%.
Pharmaceutical manufacturers, already grappling with higher production costs, face significant challenges securing the resources they need.
The broader economic downturn has exacerbated the problem. Iran’s rial has lost nearly 40% of its value since September, further restricting the ability of the pharmaceutical sector to import raw materials.
Mehdi Pirsalehi, head of the Food and Drug Organization, said earlier in January that the government owes over $4.47 billion to pharmaceutical companies, with additional debts for medical equipment.
While Health Minister Mohammadreza Zafarghandi has promised to alleviate the burden by compensating insurance companies, critics argue the measures fall short.
The government’s elimination of a $9 billion subsidy for essential goods in 2022, which was introduced to counter earlier currency crises, is widely blamed for exacerbating inflation and shortages.
Now, as president Pezeshkian plans to reduce the allocation for importing essential goods—including agricultural products, pharmaceuticals, and raw materials—to €12 billion, as outlined in the 2025 budget released in October, both patients and healthcare providers are bracing for a challenging year ahead as the new Iranian year approaches.
Several Iranian human rights organizations, internet freedom programs and activists engaged in media and civil society work have received notices that their funds will be suspended for three months, Iran International has learned.
Trump signed an executive order on January 20, his first day in office, suspending foreign development assistance for 90 days to allow for a review of its efficiency and alignment with his America First policy stance.
Following the move, the State Department has halted most ongoing foreign aid programs and paused the initiation of new assistance, according to an internal memo distributed to officials and US embassies abroad.
Official government figures show Washington is the world's biggest donor of international aid, spending $39 billion in the 2024 fiscal year, out of which $65 million was allocated to funding State Department-administered Near East Regional Democracy (NERD).
The body is the main foreign assistance channel through which the United States has supported civil society and human rights in Iran since 2009, according to the Congressional Research Service.
“We have been told in writing that we must stop all work on the program and not incur any new costs after January 24th and cancel as many obligations as possible,” said one State Department grantee.
“It doesn’t look like anyone has given thought to the implications of this decision... The lack of clarity of the notice we received is just absurd. It is unclear how long this process will take,” the person added.
The State Department did not immediately respond to a request for comment.
Supporting internet freedom
Among the grantees are Persian media outlets that publish uncensored news for Iranian citizens, as well as human rights organizations that document abuses in Iran, which is instrumental in keeping the Islamic Republic accountable.
A part of the US funds also covers the expenses of Virtual Private Network (VPN) services which ordinary Iranians used to circumvent the Islamic Republic’s censorship. Many of these services will have to stop their operation following the aid cut.
“It is a very dangerous move, because the issue of internet freedom is very vital, both to the people of Iran and the allies of Iranian people in the West,” a cyber security expert based in Silicon Valley told Iran International on condition of anonymity.
Trump’s order, an internet activist told Iran International, deprives 20 million Iranians, or a fifth of the population, of US-supported VPNs they use to bypass Tehran’s internet curbs.
At their peak during the “Woman Life Freedom” protests in 2022, VPN usage in Iran hit two-third of the population. “In today’s Iran, the internet has no meaning without VPNs,” writes internet activist Soroush Ahmadi in an article for Peace Line journal, which is published by the Virginia-based NGO “Human Rights Activists in Iran”.
The VPNs commercially available in the Iranian market are believed to be controlled by the Islamic Republic and even sold by entities affiliated with the Revolutionary Guards who profit from the needs of Iranians to gain unfettered access to the internet.
During Trump’s first term in office in 2020, US government-funded technology companies recorded an increase in the use of circumvention software in Iran after boosting efforts to help Iranian antigovernment protesters thwart internet censorship and use secure mobile messaging.
Since the 2018 protests in Iran, Washington had accelerated efforts to provide Iranians more options on how they communicate with each other and the outside world.
These included providing apps, servers and other technology to help people communicate, visit banned websites, install anti-tracking software and navigate data shutdowns, The Financial Times reported in 2020 citing a Trump administration state department official.
The second Trump administration also seemed to be pursuing the same approach toward the Iranian people before the inauguration.
Maximum pressure on people or government?
Secretary of State Marco Rubio said in his Senate confirmation hearing earlier this month that “anything that we do with Iran needs to be clear eyed about who that regime is, but also who those people of Iran really are, because they're not their leaders.”
However, an internet expert told Iran International that the new decision “stands in contrast to the Trump administration’s stated position of supporting the Iranian people against the Islamic republic.”
“In reality, this policy will exert maximum pressure on the Iranian people rather than the government. It will trap Iranian citizens behind a digital wall and assist the government in building its national internet, effectively isolating the nation from the rest of the world,” the expert said.
‘Worst form of punishment’
The Silicon Valley-based cyber security expert says the contradiction between Rubio’s words and the executive order “will raise serious questions in the minds of many Iranians, because this is the worst form of punishment for the people of Iran.”
“With the relentless censorship and oppression by the Islamic Republic, if the current form of support for internet freedom outside Iran disappears, it would in a way be the greatest gift from the Trump administration to the tyrants in Tehran,” the expert added.
“With a stroke of the pen, Trump’s executive order and Rubio’s memo implementing it have done what the Iranian regime could not do after spending billions of dollars on their national Internet: cut off the last channel to the global internet that Iranians had,” said the Iranian internet activist.
The decision not only undermines the free flow of information and access to free internet for Iranian people, it also “disrupts many civil society activities, including secure communication with one another, which strengthens civil society and is essential for safe organization,” according to Ahmad Ahmadian, head of California-based tech non-profit.
“Moreover, it allows the Iranian government to dominate the public narrative by silencing people's voices through cutting off their access to information tools and censored social media in Iran,” added Ahmadian whose company Holistic Resilience aims to advance internet freedom and privacy by developing and researching censorship circumvention.
Big Tech
Last September, the White House convened a meeting with representatives of Amazon, Alphabet's Google, Microsoft, Cloudflare and civil society activists in a bid to encourage US tech giants to offer more digital bandwidth for government-funded internet censorship evasion tools.
The tools, supported by the US-backed Open Technology Fund (OTF), have seen a surge of usage in Iran and other authoritarian states that heavily censor the internet, Reuters reported at the time.
However, Big Tech may not be willing or able to continue their support for providing anti-censorship tools without the US government’s funds.
“The leadership of the US government has been crucial in urging big tech companies to provide public services,” says Ahmadian. “Without the encouragement of the US government, these companies wouldn't take the initiative on their own.”
After the nationwide 2022 protests began in Iran, the Iranian government severely restricted internet access for its citizens.
In response to the restrictions, which included complete and periodic internet shutdowns and slowing down of internet speeds, the US government lifted some curbs on exporting internet services to Iran, allowing Elon Musk’s SpaceX to provide satellite internet services.
By the end of 2024, the number of Starlink satellite internet users in Iran surpassed 100,000, a senior industry official in Iran said earlier this month, underscoring the keenness of Iranians to defy curbs on their access to the outside world.
Impact on human rights projects
However, the consequences of Trump’s executive order will not remain limited to internet censorship circumvention tools, activists say.
The pause in US foreign aid, a human rights activist told Iran International, “(will) impose restrictions on projects that address human rights violations or investigate governmental and military corruption which have impacted Iran's economy and social conditions in favor of foreign terrorist activities and money laundering.”
"This decision by the Trump administration would be a reciprocal gift to the Islamic Republic and its corrupt officials, the Revolutionary Guard, and money-laundering networks in the West," the activist, speaking on condition of anonymity, added.
The activist said several non-Iranian American institutions have been using these funds to investigate corruption and money laundering by the Islamic Republic in environmental and construction sectors. “These organizations will be forced to halt their activities,” he added.
Several activists speaking to Iran International believe that if the projects related to promotion of human rights and internet freedom in Iran do not receive an exemption within the next month, they will either collapse entirely or be deeply curtailed.
“The impact of this freeze might not be immediately noticeable, but its severe implications will become evident over time,” a second human rights activist said.
Internet experts warned that even if US aid starts again in three months, the damage is irreversible since many people had migrated to vulnerable domestic VPNs and might never fully return to using US-backed secure services.
“This issue jeopardizes both the freedom of information and the security of individuals," said the Silicon Valley expert.
Speaking to the semi-official ISNA news outlet, Takht-Ravanchi emphasized that Iran will not negotiate on matters beyond its nuclear program, possibly alluding to US demands that Tehran cease interference in regional affairs.
The deputy foreign minister also revealed divisions among the original signatories of the 2015 nuclear deal, known as the JCPOA, regarding Russia’s involvement in future negotiations. France, the United Kingdom, and Germany—the E3—appear to oppose Moscow playing a significant role in talks to either revive the JCPOA or draft a new agreement.
This stance aligns with the European Union’s broader efforts to diplomatically and economically isolate Russia.
Iran has so far held two rounds of what it describes as “consultations,” rather than negotiations, with the E3 in December and January.
While President Trump has yet to articulate his approach toward Iran, it is widely believed he will strengthen sanctions to pressure Tehran into talks favorable to Washington.
Iran engaged in 18 months of indirect negotiations with the Biden administration between 2021 and 2022 to restore the United States’ participation in the JCPOA after Donald Trump unilaterally exited the agreement in 2018, imposing harsh sanctions on Iran. However, the Vienna talks ended without a deal, particularly after Russia’s 2022 invasion of Ukraine, which fueled speculation about whether Tehran was genuinely interested in an agreement or merely seeking to ease sanctions.
Takht-Ravanchi reiterated Iran’s official stance that Trump’s “maximum pressure” campaign had failed. “They even harbored the illusion that a few months after the US withdrawal from the JCPOA and the imposition of multiple pressures, Iran would eventually relent and agree to a deal based on their demands. As noted, this did not happen, proving that the policy of maximum pressure on Iran has failed,” he said.
However, many media outlets and social media users in Iran highlight the severe economic crisis gripping the country since 2019, following the enforcement of full US oil sanctions.
Iran’s currency has lost 95% of its value since 2018, while inflation has averaged around 40% annually over the past five years. An estimated 20-30 million Iranians have fallen below the official poverty line, defined as a $450 monthly income for a family of three. Despite this economic hardship, Iran has managed to sell over $100 billion worth of oil to China since 2021, partly due to a more relaxed enforcement of Trump-era sanctions under the Biden administration.
Takht-Ravanchi dismissed claims that the Islamic Republic’s influence has weakened over the past six months due to regional developments, including setbacks for Hezbollah and the fall of its ally Bashar al-Assad in Syria. These events have fueled speculation that Tehran is now in a weaker position ahead of any potential future talks with the United States.
“The Middle East is constantly changing, and today’s circumstances may not define tomorrow’s reality,” Takht-Ravanchi argued. “Those who take a deeper look at developments in West Asia agree that conclusions should not be drawn based on the fluctuations in events in the region.”
The senior diplomat, who previously served as Iran’s ambassador to the United Nations in New York, acknowledged uncertainty about Trump’s next moves. "At the moment, it is not entirely clear what Trump's policy toward Iran is, and we must wait for this policy to become defined," he remarked.