Naloxone Billing Survey (Pharmacists) Question Title * 1. Are you a pharmacy owner or employee? Owner Employee Other (please specify) Question Title * 2. Is your Pharmacy currently dispensing Naloxone Hydrochloride to patients? Yes No If not, explain why: Question Title * 3. What major questions or concerns do you have in regards to dispensing and billing for Naloxone Hydrochloride? Question Title * 4. If your pharmacy is currently dispensing Naloxone, have patients mostly been paying out-of-pocket, or is it mostly covered by the patients' health insurance? Most patients are paying out-of-pocket Mostly covered by patients' health insurance About 50% is paid by patients, 50% paid by health insurance Other (please specify) Question Title * 5. Have you experienced any obstacles or barriers when billing for Naloxone? Yes No If Yes, please specify Question Title * 6. If you are currently furnishing and dispensing Naloxone, explain how you are submitting claims and your process for documentation: Question Title * 7. If you are or are planning to furnish and dispense Naloxone, would you be interested in listing your pharmacy on the Drug Policy Alliance's website at www.naloxoneCA.org? Yes No Other (please specify) Done