The health transformation plan (HTP) introduced in 2014 has contributed to equitable accessible health care for all Iranian citizens. This article describes Iran’s HTP and how it has resulted in significant improvements in health outcomes. It summarizes the main challenges faced by Iran to achieve universal health coverage including discussions on sustainable resources, service delivery, and health governance. Finally, it proposes some practical and critical interventions, including making health financing more resilient in part by defining and implementing cost control policies and a cost-effective package of services.