Tehran University of Medical Sciences Journal of Pharmacoeconomics and Pharmaceutical Management 2383-4498 11 03 2026 10 03 26 35 Milad Keshvardoost Islamic azad university of pharmaceutical branch, Tehran, Iran. Parisa Hazratifard Islamic azad university of pharmaceutical branch, Tehran, Iran. 2025 09 29 2025 12 02 Background: Pharmacy marketing strategies play a pivotal role in shaping prescribing and dispensing behavior. Over the past decade, pharmaceutical companies have shifted their promotional approaches in response to regulatory changes, technological advances, and evolving pharmacy practices. However, little is known about how the perceived effectiveness of such strategies has changed over time. Objective: To evaluate longitudinal changes in the perceived effectiveness of pharmaceutical marketing strategies among community pharmacies in Iran between 2013 and 2025. Methods: A repeated cross-sectional survey was conducted in two waves (2013 and 2025). Pharmacies were selected randomly from the national registry, and data were collected using a mixed-methods approach combining structured questionnaires and semi-structured interviews. The questionnaire assessed the effectiveness of marketing strategies on a five-point Likert scale, covering domains such as personal relations, promotional materials, financial incentives, and product presentation. Comparative analysis across years was performed using Welch’s t-tests for mean differences, chi-square tests for distributional shifts, and effect size measures (Cohen’s d, Cramer’s V). False discovery rate (FDR) adjustment was applied to correct for multiple testing. Results: A total of 488 pharmacies in 2013 and 329 pharmacies in 2025 completed the survey. Descriptive findings indicated an overall decline in the perceived effectiveness of traditional promotional, while interpersonal strategies such as pharmacist–representative relationships and personal skills of representatives showed relative stability. Inferential analysis confirmed significant temporal differences for several strategies, with the strongest effect sizes observed in financial incentives (price reduction offers) and sampling. Thematic analysis of interviews highlighted increasing skepticism toward material-based promotion and a growing emphasis on professional trust and evidence-based information. Conclusion: This study provides the first 12-year trend analysis of pharmacy perceptions of marketing strategies in Iran. Findings suggest a shift from material-driven promotion toward relational and knowledge-based approaches. These results have implications for both pharmaceutical marketing practice and policy, underscoring the need for adaptive strategies that align with evolving pharmacy expectations. https://jppm.tums.ac.ir/index.php/jppm/article/view/264