Abstract
Background: Community pharmacies are increasingly delivering structured services to support chronic disease management, such as Multidose Drug Dispensing (MDD). This strategy can improve adherence and safety, but evidence of its economic feasibility in Portuguese pharmacies remains limited. Objective: To estimate the cost of implementing and operating an MDD system in a community pharmacy, informing reimbursement models and policy. Methods: A micro-costing approach assessed fixed and variable expenses for serving polymedicated elderly patients. Costs were calculated in euros (2024/2025) and expressed per working day based on 253 annual preparation days. Results: First-year costs totaled €70 985.68, including €8 184.00 for setup, €21 579.00 for supplies, and €41 222.68 for staff salaries. The daily operating cost was €280.58, with labour representing the major expense. A break-even analysis indicated sustainability with around 700 users at €10/month. Conclusion: Although requiring significant initial investment, MDD can become financially viable through scaling, workflow efficiency, and supportive reimbursement strategies.