Background <p>Financial protection refers to the health system’s ability to protect the population from the financial risk of ill health. Patients with cancer or special diseases are particularly vulnerable to catastrophic health spending and impoverishment, highlighting the urgent need for targeted financial protection strategies. Diseases such as haemophilia, thalassemia, dialysis, renal replacement therapy and multiple sclerosis (MS) are among the list of special diseases in Iran. This scoping review aims to identify existing strategies for financial protection for patients with cancer or special diseases in health systems.</p> Methods <p>This scoping review utilized the Arksey and O’Malley framework and used the population–context–concept model to review publications related to financial protection for patients with cancer or special diseases from 2000 to 2024. The data were collected from three databases (PubMed, Institute for Scientific Information (ISI) Web of Science and Scopus) and two search engines (Google and Google Scholar). The keywords included “financial protection,” “financial risk protection,” “health insurance coverage,” “poor people” and “health services.”</p> Results <p>A total of 4625 articles were found, 17 of which were ultimately included in the final analysis. We identified seven main types of strategies for financial protection in health systems, including purchasing, prepaid mechanisms, financial support, benefits packages, infrastructure and facilities, intersectoral collaboration and economic support.</p> Conclusion <p>Prepaid mechanisms are the most widely used main component of financial protection for patients with cancer and special diseases. Policy-makers and healthcare stakeholders must prioritize adaptable and context-specific solutions that account for local economic, social and healthcare realities.</p>