On-Line Appendix
Appendix Contents
Section 1: Full text of survey questions
Section 2: Supplementary analysis for non-response bias
Section 3: Demographic comparison with Shrank et al. (Health Affairs, 2009)
Section 4: Stratification of survey responses by demographic characteristics
Section 5: Stratification of outcome variables by racial/ethnic subgroups
SECTION 1: Full text of survey questions
Thank you for your interest in this survey on generic and brand-name prescription drugs. To determine your eligibility for the survey, please answer the following few questions. After completing these questions, you will be able to print a coupon for $2 in Extra Bucks. If you qualify based on these questions to take the rest of the short survey, you will be able to earn another $15 in Extra Bucks.
In general, would you describe your health as (check one box):
Excellent
Good
Fair
Poor
In what year were you born? (enter 4-digit year) ______
What is the ZIP code for where you live (enter 5 digits): ______
Please describe your gender (check one box):
Male
Female
Have you ever been told a doctor, nurse, or other health professional that you had any one of the following health conditions:
· Anemia or a low red blood cell count.
· Atrial fibrillation.
· Blood clot or pulmonary embolus.
· “Colitis” or diarrhea caused by a bacterial infection such as Clostridium difficile (“C diff”) or Staph aureus.
· Depression/major depressive disorder.
· Diabetes.
· Heart attack or “myocardial infarction”.
· Osteoporosis or “thin bones”.
· Panic attack or anxiety disorder/generalized anxiety disorder.
Yes
No
How many prescriptions for drugs have you filled or refilled at any pharmacy in the last 3 months?
0
1-4
5 or more
[TEXT NOT INCLUDED IN SURVEY: Respondents progress if they answer “yes” to chronic health condition question and either “1-4” or “5 or more” to prescription drug filling question.]
Congratulations on qualifying for the remainder of the survey! You will be able to print a coupon for $15 in Extra Bucks by completing all of these questions to the best of your ability.
We are interested in your thoughts about generic and brand-name drugs. A brand-name drug is manufactured and patented by a single drug company, usually the first to bring it to market. After its patent expires, other companies are free to manufacture and sell it; this is the generic version of the drug.
As you complete the survey, please answer each question based on the information provided. Thank you for your time and effort!
Do you think that brand-name prescription drugs are:
More expensive than they should be?
Priced about right?
Cheaper than they should be?
Do you think that generic prescription drugs are:
More expensive than they should be?
Priced about right?
Cheaper than they should be?
Prescription drugs that have been on the market for a long time are likely to be______than drugs that are newly on the market. (Fill in the blank with one option below)
Safer
Neither more nor less safe
Less safe
Newer drugs are ______better than older ones. (Fill in the blank with one option below)
Always
Usually
Sometimes
Rarely
Never
How comfortable do you feel taking a generic drug that was prescribed for you by your doctor?
Very comfortable
Somewhat comfortable
Somewhat uncomfortable
Very uncomfortable
If your doctor prescribed a brand-name drug, how comfortable would you be if your pharmacist filled the prescription with an FDA-approved generic version of that drug?
Very comfortable
Somewhat comfortable
Somewhat uncomfortable
Very uncomfortable
How often do you think your doctor should prescribe a generic drug for you if one is available?
Always
Usually
Sometimes
Rarely
Never
Overall, do you think Americans should ...
Use more generic drugs than they do now?
Use about the same amount of generic drugs as they do now?
Use fewer generic drugs than they do now?
How would you feel if your health insurance company required use of a generic version of a brand-name drug that your doctor prescribed, if one is available and FDA-approved?
I would approve of this approach
I would have no opinion on this approach
I would not approve of this approach
I do not have health insurance
In general, how do you feel about taking a generic vs brand-name drug? Would you say you:
Much prefer a brand-name drug
Slightly prefer a brand-name drug
Don't prefer one or the other
Slightly prefer a generic drug
Much prefer a generic drug
Do you think generic drugs are as effective as their brand-name versions?
Definitely yes
Probably yes
Not sure
Probably not
Definitely not
Do you think generic drugs are as safe as their brand-name versions?
Definitely yes
Probably yes
Not sure
Probably not
Definitely not
Do you think generic drugs have the same side effects as their brand-name versions?
Definitely yes
Probably yes
Not sure
Probably not
Definitely not
Do you think generic drugs are made of the same active ingredients as their brand-name versions?
Definitely yes
Probably yes
Not sure
Probably not
Definitely not
Do you think generic drugs are less expensive than their brand-name counterparts?
Definitely yes
Probably yes
Not sure
Probably not
Definitely not
How comfortable do you feel asking your doctor to write a prescription for a generic drug if one is available?
Very comfortable
Somewhat comfortable
Somewhat uncomfortable
Very uncomfortable
How comfortable do you feel asking your pharmacist to substitute a generic version of the brand-name drug your doctor prescribed?
Very comfortable
Somewhat comfortable
Somewhat uncomfortable
Very uncomfortable
In the last year, how often have you asked your doctor to prescribe a brand-name drug rather than a generic?
4 or more times
2-3 times
1 time
Never
We have a few more questions about you. For each question, please check the one best answer.
Please describe your level of education (check one box):
High school or less
Some college
College graduate
Some graduate school
Please describe your race or ethnicity (check as many as apply):
African American
Hispanic
Asian/Pacific Islander
Caucasian/White
Other; Write in: ______
Please estimate your total household income in 2013 (check one box):
< $15,000
$15-30,000
$30-50,000
$50-75,000
$75-100,000
$100,000
SECTION 2: Supplementary analysis for non-response bias
A key methodological issue facing studies based on surveys is the representativeness of the respondents. Following Johnson and Wislar, we compared early vs. late survey responders, since late respondents’ data may be predictive of how non-respondents would have answered these questions. As noted in the manuscript, our survey distribution plan included up to 11 further emails to encourage participation. Late respondents were defined as those occurring in the second half of all respondents. We compared early vs. late respondents on the basis of their demographic characteristics in Table 1 (Appendix Table 1). These results show high levels of consistency between early respondents and late respondents. Some variations were noted; for example, as compared to the late respondents, a slightly higher ratio of early respondents had the lowest household incomes (<$30,000). However, in surveys with large numbers of people that involve multiple comparisons, there is a high likelihood that some questions will show significant differences. Overall, the concordance we found among early and late respondents supports the generalizability of our respondents to the entire sample.
Appendix Table 1. Demographic characteristics of early and late survey respondents
Characteristic / Early Respondents% (n/N respondents) / Late Respondents
% (n/N respondents)
Level of education
· High school or less
· Some college
· College graduate
· Some graduate school / 12 (45/369)
28 (102/369)
37 (137/369)
23 (85/369) / 10 (36/369)
33 (122/369)
33 (122/369)
24 (89/369)
Race/ethnicity
· Caucasian/White
· Non-Caucasian / 79 (287/364)
21 (77/364) / 75 (274/364)
25 (90/364)
Total 2013 household income
· < $15,000
· $15-30,000
· $30-50,000
· $50-75,000
· $75-100,000
· > $100,000 / 7 (25/363)
12 (45/363)
17 (61/363)
28 (103/363)
15 (56/363)
20 (73/363) / 4 (13/365)
9 (33/365)
19 (70/365)
25 (92/365)
17 (64/365)
25 (93/365)
Sex
· Male / 44 (162/369) / 38 (142/369)
· Female / 56 (207/369) / 61 (227/369)
Age, mean years / 50 (SD: 13) / 49 (SD: 13)
Self-reported health status
· Excellent
· Good
· Fair
· Poor / 6(24/369)
53 (197/369)
36 (132/369)
4 (16/369) / 5 (18/369)
57(211/369)
32 (119/369)
6 (21/369)
Rx filled/refilled in last 3 mos
· 1-4
· 5 or more / 30 (110/369)
70 (259/369) / 38 (139/369)
62 (230/369)
SECTION 3: Demographic comparison with Shrank et al. (Health Affairs, 2009)
Appendix Table 2. Demographic characteristics of survey respondents to Shrank et al.’s survey from 2009 and current survey
Characteristic / Current survey% (n/N respondents) / Shrank et al.
% (n/N respondents)
Level of education
· High school or less
· Some college
· College graduate
· Some graduate school / 11 (81/738)
30 (224/738)
35 (259/738)
24 (174/738) / 23 (245/1047)
28 (295/1047)
30 (317/1047)
18 (190/1047)
Race/ethnicity
· African American
· Hispanic
· Asian/Pacific Islander
· Caucasian/White
· Other / 7 (48/733)
6 (46/733)
8 (61/733)
80 (586/733)
1 (10/733) / 5 (55/1047)
4 (42/1047)
3 (31/1047)
86 (904/1047)
1 (15/1047)
Total annual household income
· < $15,000
· $15-30,000
· $30-50,000
· $50-75,000
· $75-100,000
· > $100,000 / 5 (38/728)
11 (78/728)
18 (131/728)
27 (195/728)
16 (120/728)
23 (166/728) / 4 (46/1047)
13 (140/1047)
25 (266/1047)
23 (245/1047)
17 (178/1047)
16 (172/1047)
Sex
· Male / 41 (306/742) / 33 (341/1047)
· Female / 59 (436/742) / 67 (706/1047)
Age, mean years / 50 (SD: 13) / 51.6 (SD: 15.4)
Self-reported health status
· Excellent
· Good
· Fair
· Poor / 6 (43/742)
55 (410/742)
34 (252/742)
5 (37/742) / 10 (106/1047)
73 (764/1047)*
14 (152/1047)
3 (35/1047)
Rx filled/refilled in last 3 mos
· 1-4
· 5 or more / 34 (251/742)
66 (491/742) / N/A
N/A=Data not available
* “Very good” and “good” condensed to “good”; respondents given 5 options in Shrank et al. survey. Numerators otherwise copied verbatim from original paper.
2
SECTION 4: Stratification of survey responses by demographic characteristics
Appendix Table 3a: Breakdown of survey results related to patients’ perceptions about use of generic drugs (Table 2) by demographic characteristics
Whether your doctor should prescribe a generic drug for you if one is available / Male gender %(N range 304-305) / Female gender %
(N range 428-435) / Excellent health %
(N range 42-43) / Good health %
(N range 405-408) / Fair health %
(N range 248-252) / Poor health %
(N 37)
Always / 44 / 46 / 70 / 42 / 45 / 49
Usually / 38 / 38 / 23 / 41 / 36 / 35
Sometimes / 18 / 15 / 7 / 15 / 19 / 16
Rarely/never / 0 / 1 / 0 / 1 / 1 / 0
Safety of prescription drugs on the market for a long time vs. drugs newly on the market
Safer / 57 / 51 / 53 / 53 / 54 / 49
Neither more nor less safe / 42 / 49 / 44 / 46 / 45 / 51
Less safe / 1 / 1 / 2 / 1 / 0 / 0
Whether newer drugs are better than older ones
Always/usually / 24 / 13 / 21 / 17 / 16 / 24
Sometimes / 73 / 85 / 79 / 81 / 81 / 68
Rarely/never / 2 / 3 / 0 / 2 / 3 / 8
Americans’ use of generic drugs
Use more / 70 / 66 / 74 / 68 / 68 / 59
Use about the same amount / 26 / 28 / 16 / 28 / 27 / 35
Use fewer / 4 / 6 / 9 / 4 / 5 / 5
Preference in taking generic vs brand-name drug
Prefer a brand-name drug / 39 / 37 / 30 / 38 / 38 / 32
Don’t prefer one or the other / 33 / 37 / 49 / 35 / 33 / 38
Prefer a generic drug / 28 / 27 / 21 / 27 / 29 / 30
How often asked doctor to prescribe a brand-name drug rather than a generic in the last year
4 or more times / 16 / 15 / 14 / 15 / 17 / 11
2-3 times / 21 / 19 / 14 / 20 / 23 / 11
1 time / 12 / 9 / 17 / 7 / 12 / 24
Never / 51 / 57 / 55 / 58 / 48 / 54
Appendix Table 3b: Breakdown of survey results related to patients’ perceptions about use of generic drugs (Table 2) by demographic characteristics