Challenges of implementing health technology assessment in the Iranian pharmaceutical industry.

BACKGROUND: Health technology assessment remains underdeveloped in the Islamic Republic of Iran, with limited systematic application in the pharmaceutical sector. AIM: To identify the challenges facing the development and implementation of health technology assessment in the Iranian pharmaceutical industry. METHODS: Between August and November 2024 we conducted in-depth interviews with 15 experts who have experience in implementing health technology assessment, on the development and implementation of health technology assessment in the pharmaceutical sector of Islamic Republic Iran. We used MAXQDA version 12 for data management and analysed the data using the Braun and Clarke's 6-step thematic analysis. RESULTS: The major challenges identified were the absence of centralised health technology assessment governance for pharmaceuticals, insufficient and unstable funding, resistance to change, limited awareness about health technology assessment, limited health technology assessment capacity, absence of a legal enforcement framework, political interference, and the strong influence of pharmaceutical companies. Participants noted the availability of international partnerships on health technology assessment. CONCLUSION: Several complex and multilevel barriers hinder the development and implementation of health technology assessment in the Iranian pharmaceutical industry. There is a need for actions to strengthen health technology assessment in the country to support evidence-based policymaking, resource optimisation and equitable access to essential medicines.