Note: This survey applies only to prices of opioids for use outside of the hospital (not for in-patients) which are dispensed at private or public pharmacies. Pharmacies may be located outside or inside a hospital but the survey applies only to opioids be used outside of hospital.

Gathering the information:

1. Select a public health facility (hospital) which provides diagnostic and treatment services for patients with life-threatening conditions such as HIV and cancer.
2. Select the closest pharmacy to this facility - may be a licensed retail pharmacy or it may be a pharmacy located inside the facility (“hospital pharmacy”) which dispenses opioids to outpatients.
3. Ask to speak to the Chief Pharmacist or the person in charge, and let him/her know that you are participating in this study. Show him/her the letter introducing you as a participant in this study.
4. Inquire if at least one of the opioids included in the study are available. If opioids are not available or the pharmacist is unwilling to cooperate, go to the next nearest pharmacy. Continue this process until you locate one which has at least one opioid available.
5. When you locate a pharmacy that has available at least one of the opioids included in the study, complete this form and submit the information.

Click here for examples that will guide you.

For the purpose of this study:
The dispensed price includes the pharmacy selling price plus any dispensing fees and any sales taxes, if applicable to patients. Available refers to availability for purchase by patients arriving at the pharmacy with a medical prescription at the moment the survey is completed.

State in your local currency the lowest retail dispense price of the smallest selling dose and unit for the opioid formulations available on the day you complete this form.

If your country has a tiered system in which medicines (including opioids) are priced according to the person’s income level or if they are subsidized for all patients, report the price that a patient earning the lowest minimum wage would have to pay.

This survey does not apply to prices paid by individuals who are covered by private insurance schemes. It applies only to individuals who do not have a private insurance and may or may not be covered by a public insurance or government subsidy.

All fields are required.

Note: All the identification and contact information will be confidential. The purpose of asking for this information is to prevent potential duplication from the same sources. The pharmacy address will be used to calculate access based on population.