title: The impact of community pharmacy dispensing fees on the introduction of buprenorphine - naloxone in Australia.
abstract: OBJECTIVE
  The introduction of buprenorphine - naloxone in Australia in April 2006 has permitted the revision of takeaway policies in many states and has introduced the possibility of unsupervised treatment. This study explored the implications of the introduction of buprenorphine - naloxone in terms of cost to patients through a survey of pharmacists' intended pricing practices. The aim of the research was to examine the intentions of pharmacists in relation to fees for buprenorphine - naloxone and study the potential implications to patients when compared with the existing fee structure for methadone and for buprenorphine alone.
  
  
  METHODS
  A self-complete questionnaire was mailed to every community pharmacy in New South Wales (NSW) (n = 593) dispensing methadone or buprenorphine to people with opioid dependence. A response rate of 68.6% (n = 407) was achieved after three mailouts.
  
  
  RESULTS
  The majority of pharmacies charged a flat weekly fee for methadone (92.2%; mean = $31.90) and buprenorphine (74.8%; mean = $31.00). The mean intended fees for buprenorphine - naloxone according to different dosing and takeaway regimens ranged from $19.19 per week for no supervised doses and fortnightly takeaways to a $30.88 per week flat fee. There appeared to be little variation in fee structure irrespective of the takeaway regimen, until reaching the 2 weeks' unsupervised dose regimen.
  
  
  CONCLUSIONS
  This study highlights the importance of the early dissemination of unambiguous information regarding the introduction of a new medication, especially where supervised dispensing through community pharmacies is essential to the provision of treatment. The potential impact upon the successful rollout of a new treatment paradigm that was developed to benefit stable patients in the community may be jeopardised when such processes are not followed.
authors.affiliation: Drug Health Services, Sydney South West Area Health Service, Australia. adam.winstock@sswahs.nsw.gov.au
authors.forename: Adam R
authors.initials: AR
authors.lastname: Winstock
authors.forename: Toby
authors.initials: T
authors.lastname: Lea
authors.forename: Alison
authors.initials: A
authors.lastname: Ritter
mesh_terms: D002047:Buprenorphine / Q000008:administration & dosage / Q000191:economics*; D003365:Costs and Cost Analysis; D023801:Directly Observed Therapy / Q000191:economics* / Q000706:statistics & numerical data; D004338:Drug Combinations; D006801:Humans; D033182:Intention; D009270:Naloxone / Q000008:administration & dosage / Q000191:economics*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000191:economics*; D009517:New South Wales; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000191:economics / Q000534:rehabilitation; D010349:Patient Compliance; D010594:Pharmacies / Q000191:economics*; D011306:Prescription Fees; D011795:Surveys and Questionnaires
chemical_list: D004338:Drug Combinations; D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine