OBJECTIVES: The aim of this study was to assesses the affordability of Cardiovascular disease medication in Iran also examine the level of catastrophic expenditure incurred by CVD-affected households during medication therapy. METHODS: Data was collected for all CVD medicines that listed in Iran drug list. The information of DDD were extracted from the WHO website. Also based on the clinical expert’s opinions the minimum and the maximum daily dose was extracted from related guidelines. The lowest paid unskilled worker earned US$ 8. 8 using the exchange rate at the time of analysis. Having to spend more than 1 day’s income per month could be considered to be unaffordable. Then, by comparing these levels with the income of different income groups of the Iran society, the catastrophic expenditure was evaluated. Medication cost were considered catastrophic if their combined cost was more than 2% of household capacity-to-pay. We compared results from different indication. Contains: Acute Coronary Syndrome (ACS), angina, anti-arrhythmia, Heart Failure (HF), hypertension, hyperlipidemia. In each mentioned sub groups the mono-therapy as well as combination therapy and scenario-centric have been determined. RESULTS: the results show that by using DDD method, 10, 13, 21,12,14, and 0 percent are no affordable in ACS, angina, anti-arrhythmia, HF, hypertension, hyperlipidemia group, respectively. In addition, Chronic treatment of CVD medication cost more than one day's wages in many cases of MAX/MIN method. In particular, the results of scenario-centric method show that when monotherapy is insufficient, treatment became unaffordable most likely. ACS and anti-Arrhythmia face with catastrophic payments. Labetalol 5mg/ml was catastrophic for every 10 income groups of country. Verapamil 2.5 mg/ml only for the richest group was non-catastrophic. CONCLUSIONS: High rates of catastrophic costs show that CVD patients in Iran incur substantial costs and new policies are urgently needed to ensure CVD medication is actually affordable for CVD patients.