Page 70 - GHES-3-3

Global Health Economics and
Sustainability
Pharmaceutical system in Iraq

private pharmaceutical distributors are required to be government. These inefficiencies, compounded by funding
licensed in accordance with the relevant regulations and shortages, have allowed the private sector to outcompete
laws for practicing in Iraq. KIMADIA in procurement (Al-Mosawi, 2020).
Since Iraq does not have dominant players or 4.2. Approval and listing of medicines
established pharmacy chains, community pharmacies are
typically independently owned and operated by practicing The DTA is responsible for the regulation of medicine
pharmacists. These pharmacies receive their stock from and pharmaceutical product licensing in the public and
wholesale pharmaceutical suppliers and are responsible private sectors (Figure 3) (Al-Jumaili et al., 2021). The
for dispensing and compounding medications directly licensing process involves a product review by seven
to patients (Al-Jumaili et al., 2013). As of 2023, the ratio technical committees. When certifying medicines,
of community pharmacies to individuals was 1:2,950, the DTA considers the decisions of foreign regulatory
with a notable concentration in larger cities (Syndicate agencies. For international producers, a Certificate of
of Iraqi Pharmacists, 2023). Between 2011 and 2023, the Good Manufacturing Practice (GMP) and a Certificate
number of private distributors increased nearly three- of Pharmaceutical Product (CPP) from at least one of the
fold for scientific bureaus from 296 to 710, community DTA-approved foreign regulatory agencies are mandatory
pharmacies expanded from 5,336 to 15,424, and wholesale (Republic of Iraq Ministry of Health, 2020). In contrast,
pharmaceutical suppliers increased 46% from 311 to 454 local manufacturers are not required to present foreign
(Al-Jumaili et al., 2013; Syndicate of Iraqi Pharmacists, certifications. Instead, the DTA evaluates product quality
2023a, Syndicate of Iraqi Pharmacists, 2023b; Syndicate of and reliability through on-site inspections (Al-Jumaili
Iraqi Pharmacists, 2023c). et al., 2021).

4. Processes within the pharmaceutical sector In an attempt to mitigate medicine shortages, the DTA
introduced a fast-track registration scheme (Al-Jumaili
4.1. Selection and listing of medicines et al., 2021). Under this scheme, pharmaceutical products
certified by at least one accredited international foreign
The National Committee for Drug Selection is responsible
for approving and listing new medicines and vaccines in regulatory agency can receive temporary registration and
the Essential Drug List (EDL) and Comprehensive Drug an import license for 1 month after application (Al-Jumaili
List (CDL), which currently include 5,098 registered et al., 2021; Republic of Iraq Ministry of Health, 2020).
medicines and 1,014 registered supplements (Al-Jumaili This initiative has significantly increased the number of
et al., 2021; Republic of Iraq Ministry of Health, 2012). registered medicines and the availability of vaccines in Iraq
(Republic of Iraq Ministry of Health, 2020).
The EDL comprises medicines and vaccines intended
for use in public healthcare settings (Republic of Iraq 4.3. Pricing of medicines
Ministry of Health, 2012). It is subdivided into three In the public sector, the DTA is responsible for determining
volumes, numbered by priority for availability and the prices of medicines. Prices are set based on the brand
procurement policies. Volume I includes the most cost- and the geographical location of the manufacturers.
effective medicines and products, which the MoH, through Once prices are established, KIMADIA is authorized to
KIMADIA, is solely responsible for securing in the public independently procure medicines on the open market in
sector (Republic of Iraq Ministry of Health, n.d.a; Republic accordance with the needs of the public healthcare system.
of Iraq Ministry of Health, 2012). In contrast, volumes
II and III contain less prioritized items that healthcare In the private sector, the government does not
facilities may procure independently based on demands intervene to ensure reasonable pricing. However,
(Republic of Iraq Ministry of Health, 2012). New expensive the MoH, in collaboration with the SIP, encourages
medicines are reviewed by the National Committee for Drug compliance with the prices recommended by the DTA
Selection in collaboration with the Department of Need (Syndicate of Iraqi Pharmacists, 2021b). Despite these
Estimation after conducting socioeconomic assessments to efforts, the MoH reported that only 20% of the products
evaluate their market suitability. At present, the EDL lists distributed in the private market adhered to the SIP
1,105 items, approximately half of which fall under Volume pricing guideline (Republic of Iraq Ministry of Health,
I. However, only 60% of those medicines were provided 2019a). This widespread lack of price compliance can be
by KIMADIA (Al-Jumaili et al., 2021; Republic of Iraq attributed to monopolistic and oligopolistic behaviors in
Ministry of Health, 2020). This lack of public sector supply the private sector, where certain enterprises have gained
is attributed to lengthy bureaucratic procedures along majority control over the supply and distribution of certain
with weak interdepartmental coordination within the medicines (Al-Mosawi, 2020; Republic of Iraq Ministry of

Volume 3 Issue 3 (2025) 62 https://doi.org/10.36922/GHES025110025