Objectives: Millions of people in both rich and poor countries can’t seek care due to financial catastrophe and impoverishment effects. This study aimed to assess financial burden of out of pocket (OOP) payments to purchase anti-diabetic medicines for type 2 patients in Iran.

Methods: First, Different treatment schedules were defined for type 2 diabetes disease management. Then Catastrophe antidiabetic medication therapies and the proportion of households facing catastrophic payments for procuring them were assessed using the budget share and capacity to pay approaches through the aggregated data in 2019. The thresholds were adjusted for pharmaceutical sectors.

Results: The results show that the mono-dual and in some cases triple oral therapies were have no catastrophic effects when households procuring them even in rural areas. However, the poorer households and those who were resistance to first line treatments were at increased risk of pharmaceutical catastrophe expenditures. Insulin had a major catastrophe effect when it was added to the treatment schedules and lack of financial protection intensified it, more. Generally, the numbers of catastrophe treatment and population at risk of catastrophic expenditures in “budget share” were higher than “capacity to pay” approach.

Conclusions: Assessing medication treatment affordability instead of single medicines assessment is needed. This could be done by utilizing macro-level data approach and also by applying adjusted pharmaceutical sector threshold value. Considering catastrophic variation between treatment schedules, targeted pharmaceutical policies and reimbursement decisions are recommended to promote Universal Health Coverage (UHC) and protect vulnerable population from hardship.