The escalating cost of pharmaceuticals in Iran has imposed a significant burden on the health budget and increased patients' out-of-pocket (OOP) expenditures. The Darooyar plan was introduced in July 2022 to reduce drug costs and expand insurance coverage, though its success has been challenged by financial and infrastructural constraints. This before-and-after repeated cross-sectional study evaluated the impact of the Darooyar plan on OOP payments among insured patients in Fars province. Financial statements from Shahid Faghihi and Shahid Dastgheib hospitals were reviewed for six months before and after the plan's implementation using a census method. A total of 7,099 outpatient bills were analyzed before and 20,026 after implementation, alongside 8,329 inpatient bills before and 9,877 after. Monetary values were converted from Iranian Rials to international dollars using the World Bank's 2022 PPP conversion factor (71,211 IRR per international dollar). Data were analyzed using descriptive statistics and independent-samples t-tests.


Results showed that for outpatients, the average total prescription value increased from 133,504 PPP to 526,374 PPP, while the patient's OOP share rose from 25,751 PPP to 104,046 PPP, representing a 0.5% increase. Conversely, for inpatients, the insurance organization's share increased significantly while patients' OOP payments decreased notably (p < 0.05). The plan successfully increased insurance coverage and reduced financial burden for inpatients covered by Social Security and Iran Health Insurance schemes. However, uninsured patients and those in special insurance schemes experienced increased financial pressure. To optimize implementation, revising tariff policies, securing sustainable financing, and strengthening monitoring systems are recommended.