A National Funding Model for Pharmacotherapy Treatment for Opioid Dependence in Community Pharmacy

Project Details
Project ID: 2007/08-05
Type: Commissioned
Status: Completed
Institution: PriceWaterhouseCoopers
Chief Investigator: Dr Anne-Marie Feyer

Project Summary

Background: The efficacy of pharmacotherapy treatment for opioid dependence is well supported; its effectiveness is reliant on accessibility and the affordability of users to stay in treatment.

Objective: To trial a nationally consistent funding model for the provision of pharmacotherapy treatment in the community pharmacy. The funding model was comprised of a subsidy for client treatment costs and improved incentives for pharmacists.

Methods: A six-month randomised controlled trial was undertaken with 79 pharmacies. Randomisation of pharmacies occurred at a ratio of 2:1 (intervention: control). Data collection included monthly dosing data, a client survey and an activity based costing study. A total of 749 clients were recruited.

Results: A reduction in client treatment costs did not result in a statistically significantly improvement in compliance with the treatment regimen, retention in treatment or broader health outcomes. The data showed that overall there was a high level of compliance and retention for both groups. Client payments in the community pharmacy setting are highly variable by jurisdiction and by pharmacy and those clients who were paying less than an average of $29.80 per week were significantly more likely to be compliant with the treatment regimen than those who were paying more than $42.50 per week in fees. This indicates that affordability significantly impacts the ability of clients to maintain treatment. The observational study identified six service delivery models which reflected client health need and pharmacy business models. It identified the extent of flexibility in client care delivered by community pharmacy which adds a level of complexity to the pharmacotherapy service. These data provide a platform for associating systematic variation in service delivery with a costing, analogous to more or less complex procedures, as the basis for costing as in other areas of healthcare delivery, eg emergency care.

Conclusion: The findings suggest that key elements of any future national funding model should include: (1) a client subsidy that takes into account the base cost of client payments, in order to achieve equitable financial impact across the client group; (2) incorporate some level of incentive for pharmacists to retain existing service providers and to attract new pharmacies into the program; and (3) consumables were found to be an important cost element in providing the service and should be factored into a national funding model.