Iran’s health transformation plan (HTP) came into force in 2014 to counter the increasing health care and out-of-pocket expenditure in the country. This study was conducted to investigate the direct increase in the expenditures of the Iranian health system in HTP. The authors found a range of factors that significantly increase the cost of HTP, for example, an inadequate supply chain and irrational purchasing. The paper identifies potential solutions to tackle these challenges and reduce expenditures in HTP in Iran, for example, government cost control strategies.