Essential Medicines List for Diabetes in Health System of Iran

Introduction: The essential medicines list (EML) is a set that fulfills the priority of a community s medication needs. This list specifies what medications should be available at satisfying quantity and quality, by appropriate dosage forms, as well as affordable price. Recent studies show that at least 3 million diabetic patients live in Iran. The aim of this study was to determine the national EML for diabetes in Iran for adult and children groups separately and to classified the essential medicines based on VEN system and level of access. Methods: In this study, after reviewing the literature and the EML of the WHO and other countries (including Australia, Greece, and Pakist an), a questionnaire, containing allpotential medications of national EML, was prepared. This questionnaire included various medication dosage forms and dosages, price, imported or domestic production, multiplicity of supplier sources and presence in the EML of reference countries and WHO. Then, diabetic specialists in different parts of the country decided on the final list. The consensus was made through the Delphi method in three rounds. Inthe next step, the medicines in the final list were analyzed using the VEN system. In addition, to assess the level of access to the listed drugs, the accessibility level was determined by the experts’ panel. Results: The result of this study suggested a list of essential anti-diabetic medicines in Iran; including Glibenclamide 5mg ،Insulin Regular Human, Insulin Isophane 5ml, Metformin 500 mg (Extended- Release), Metformin500 mg, Pioglitazone 30mg, Sitagliptin 50mg. The results of VEN analysis showed that for adults 1) the vital drugs: Metformin, Insulin Regular, Insulin Isophane, Glucagon. 2) the essential drugs: Pioglitazone and Sitagliptin. 3) the non-essential but necessary drug is Glibenclamide. For children, 1) the vital drugs: Insulin Regular, Insulin Isophane, Glucagon. 2) the non-essential but necessary drug is Metformin. In addition, accessibility assessment revealed that for most drugs on the list, accessibility levels were acceptable in community pharmacies, with the exception of Glucagon which has the hospital access level. Conclusion: Although global organizations such as WHO annually publish an EML for developing countries, these organizations recommend that each country has its own EML for various diseases, depending on their circumstances. The results of this study can be used by the authorities in the field of pharmaceutical affairs in evaluating and monitoring the market supply and provision with the aim of bettercontrol and treatment of diabetes in emergency situations.

Keywords:

Diabetes , Essential Medicines List , Access , VEN system , Iran health system