OBJECTIVES: The global and national burden of non-communicable diseases (NCD) continues to rise making access to essential medicines increasingly important. The objective was to compare the results of two national reports conducted in 2007 versus 2014 in Iran in terms of price, availability and affordability. METHODS: The data for selected medicines for NCD were collected from public and private sector retail pharmacies and from private pharmacies located in public hospitals in six cities of Iran. The data was collected using standardized methodology developed by the World Health Organization (WHO) and Health Action International (HAI). Medicines that were common in both surveys with the same strength and dosage form were gathered. The outcome measures were percentage availability of drugs, drug price ratios to international reference prices and affordability. Availability of medicines was compared in forms of originator brand (OB) and Lowest Priced Generic (LPG). While affordability was defined as the number of days’ wages needed by the lowest-paid unskilled worker to afford one month supply of chronic treatment. The median price ratios didn’t alter after adjusting for annual inflation. RESULTS: Affordability of essential treatments was reasonable (<1) in both years and there was no significant change in affordability of common treatments between 2007 and 2014. A negligible decrease in affordability of generic Metformin (0.1 to 0.2 wage) and Salbutamol inhaler (0.2 to 0.3 wage) and a little increase in affordability of statins (0.3 to 0.2 wage) can be ignored due to high and variable inflation. Across all three pharmacy settings, the availability of OB has increased while the availability of LPG has decreased. The comparison of the price of surveyed medicines reveals a reduction in median prices of both OB and LPG in all three settings. CONCLUSIONS: Although NCD treatments are mostly available and affordable in Iran during past years, more improvements are still needed.