PATIENT VIEWS (PART 1 OF A 3-PART SERIES)

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1 (PART 1 OF A 3-PART SERIES) powered by:

2 The physician: America s most trusted OTC adviser TREATMENT SOUGHT BY CONDITION IN THE PAST 12 MONTHS 81% 31% Allergy (n=662) 11% 80% Cough-cold-flu (n=664) Source: AccentHealth Consumer Connections, % 20% 72% 30% 26% Digestives (n=629) OTC treatment Rx treatment No treatment SOURCES FOR OTC MEDICATION INFORMATION 74% 49% Pain relief (n=729) Doctor/nurse practitioner/physician assistant 67% Family/friends 53% Pharmacist 46% Websites 40% Product ad 35% In-store displays 30% Information in waiting room 25% Health magazines 21% Other 7% Social networking sites - 5% Blogs - 3% (n=914) MOST TRUSTED SOURCE FOR OTC MEDICATION INFORMATION Doctor/nurse practitioner/physician assistant 44% Pharmacist 19% Family/ friends 11% Websites 9% Product ad - 6% In-store displays - 4% Health magazines - 2% Information in waiting room - 2% Blogs - 1% Social networking sites - 0% (n=914) 21% By Natalie Hill and Sara Johnston With a growing number of Americans using OTCs to self-treat, the degree to which consumers visit their physician and the role physicians play in recommending therapy has been debated. In a recent study, AccentHealth took a look at consumer sources for OTC information, product selection drivers and the extent to which physicians influence consumer OTC purchases. Study findings re-confirm the active role physicians play in OTC brand selection, purchasing and OTC adherence. The prevalence of OTC use in the United States continues to grow. Nine-in-10 consumers surveyed reported using over-the-counter remedies, with more than half of those indicating they use always or often. Usage varies by category, with overall volume fueled by purchases in the cough-cold-flu, allergy and sinus, analgesics, and gastrointestinal categories. While consumer use of OTCs has been characterized as self-care, the physician maintains an essential role as a trusted adviser. Research shows that healthcare practitioners play a critical part in educating patients on OTC treatments and usage, and are reported to be the most commonly used source for information on OTCs (67% of consumers). Notably, 44% of consumers studied report their physician, nurse practitioner or physician assistant to be their most trusted source higher than pharmacists, family, friends and the Web. Additionally, 60% look to their doctor for specific recommendations on OTC products. Interestingly, consumers and physicians hold differing viewpoints when it comes to who is driving the discussion on OTCs. Consumers indicate that they are more often the initiator of discussions on OTCs with their physician, while physicians perceive themselves to be the catalyst. Regardless, the outcome for the patient is often an OTC treatment recommendation from his or her physician. Approximately three-quarters of consumers indicate their physician is likely to recommend an OTC following an OTC discussion. The physician as a recommender of OTC 2 APRIL 28, 2014 DRUGSTORENEWS.COM

3 OTC product discussion initiator: Perception by audience PHYSICIAN PERCEPTION* CONSUMPER PERCEPTION** PHYSICIAN 28% 13% CONSUMER 7% 37% MUTUAL/BOTH 65% 50% * n=150 ** n=689 Source: AccentHealth Consumer Connections and Encuity Research for AccentHealth, 2014 INFLUENCERS ON PHYSICIANS OTC RECOMMENDATIONS CATEGORY Top physician-recommended OTC categories (Based on average weekly recommendations*) % OF PHYSICIANS RECOMMENDING (Q1 2014) AVG WEEKLY RECOM- MENDATIONS (Q1 2014) TOTAL PROJECTED RECOM- MENDATIONS (ANNUAL)** Adult analgesics 95.0% Adult cough-cold 83.2% Adult oral antihistamines 90.9% Digestives (acid reducers) 86.6% * Weekly recommendations based on all specialties surveyed ** In millions Source: Symphony Health Solutions ProVoice Survey PRODUCT-SPECIFIC FACTORS CONSIDERED WHEN CHOOSING AN OTC MEDICINE 83% 78% 79% 75% 77% 74% Patient requests 73% In-office sampling 48% 42% 51% 49% 59% 59% 66% Coupons 27% (n=150) 39% Promotional materials Source: Encuity Research for AccentHealth, 2014 Availability Efficacy Form Indication Price Safety Physicians (n=150) Consumers (n=908) Source: AccentHealth Consumer Connections and Encuity Research for Accent Health, 2014 treatment is not new. Most physicians and 96% of those surveyed indicate they recommend OTC medicines in their practice. According to Symphony Health Solutions ProVoice Survey, adult analgesics, coughcold, antihistamines and acid reducers lead the OTC market in terms of average weekly recommendations, as reported by the physician panel of nearly 60,000 respondents. OTCs are generally perceived as a first-line defense. Seven-in-10 consumers agree that they opt for OTCs first when sick. However, using OTCs as a first line does not exclude physician involvement in treatment selection. Among those who report they use OTCs as a first-line treatment, 65% also indicate they look to their doctor for recommendations on OTC products. Additionally, 7-out-of-10 physicians, on average, report recommending OTCs to their patients as an initial course of therapy. The tendency to treat with OTC medicines is driven in large part by accessibility, with consumers and physicians reporting OTCs to be extremely convenient (63% and 57%, respectively). This attribute resonates with both consumers and physicians to CONSUMERS AND PHYSICIANS HOLD DIFFERING VIEWPOINTS WHEN IT COMES TO WHO IS DRIVING THE DISCUSSION ON OTCS. CONSUMERS INDICATE THAT THEY ARE MORE OFTEN THE INITIATOR OF DISCUSSIONS ON OTCS WITH THEIR PHYSICIAN, WHILE PHYSICIANS PER- CEIVE THEMSELVES TO BE THE CATALYST. REGARDLESS, THE OUTCOME FOR THE PATIENT IS OFTEN AN OTC TREATMENT RECOMMENDATION FROM HIS OR HER PHYSICIAN. a significantly higher degree than OTC products perceived safety or efficacy. When choosing a product to recommend, physicians report clinical attributes as being the product-specific factors considered most often, including safety (83%), indication (79%) and efficacy (78%). Whereas, consumers report price and product indication to be most top of mind when purchasing. Beyond product attributes, physicians agree that their dialogue with the patient and sales aids supplied by OTC manufacturers play a role in their decision to recommend a brand. According to physicians surveyed, patient requests (74%) and in-office sampling (73%) also have a significant impact on OTC recommendations. Study findings indicate that in-office sampling is well-received by both physicians and patients, with manufacturers receiving the benefit in the retail aisle. Physicians distribute available OTC samples: Approximately half of physi- Continued on page 4 DRUGSTORENEWS.COM APRIL 28,

4 Continued from page 3 cians surveyed indicate they have OTC samples on hand in their practice. Of those, 95% report they distribute those samples to patients; Physician trust translates to brand trust : 72% of consumers indicate they trust the products they receive from their physician; and Trust translates to purchasing: 44% of patients report having received an OTC product sample from their physician. Of those, 75% indicate they purchased the product. ACCORDING TO SYMPHONY HEALTH SOLUTIONS, 30% OF FIRST-TIME BRAND PUR- CHASES ARE INFLUENCED BY HEALTHCARE PROVIDER RECOMMENDATIONS. FUR- THERMORE, CONSUMERS PURCHASING DUE TO A HEALTHCARE PROVIDER REC- OMMENDATION SPEND MORE ON THE PRODUCT ANNUALLY THAN CONSUMERS PURCHAS- ING DUE TO PROMOTION. And so, the question presents itself: How often do patients really adhere to their physicians recommendations? Among those consumers who have received a recommendation, 9-in-10 report they typically comply with their doctors suggestions and purchase the OTCs recommended to them. Physicians are more conservative in their assessment, with 44% believing patients always or often follow their recommendations. Patients attribute drop off from recommendation to purchase to cost (66%), private-label alternatives (28%), other OTCs available at home (27%), no longer experiencing symptoms (25%) and alternative brands (9%). Many patients use previous experience to inform product selection. Patients also look to purchase OTC products that: 1. treat their symptoms; 2. are affordable; and 3. are endorsed by their physician. For those naive to a category or who feel that the available information is insufficient for them to make a treatment decision, OTC recommendations from a doctor are paramount. The influence of a doctor recommendation has a meaningful impact not only on consumer purchases, but also on the degree to which they spend. According to Symphony Health Solutions, 30% of firsttime brand purchases are influenced by healthcare provider recommendations. Furthermore, consumers purchasing due to a healthcare provider recommendation spend more on the product annually than consumers purchasing due to promotion. According to a recent study in the gastrointestinal category, consumers who made a gastrointestinal brand purchase due to a recommendation from their physician spent 63% more on the brand recommended than those exposed to advertising alone. Both consumers and physicians alike recognize the benefits of OTCs, touting brand affordability and accessibility as being most top of mind. Overall, physicians respond positively toward OTCs, with 86% expressing favorability toward the category. However, when asked about downsides, physicians do cite concerns over potential misuse and lack of physician supervision over treatment, which may lead to harmful side effects, including drug interactions or prolonged condition suffering. And so, while consumers may seek to self-treat, the consumer s most trusted adviser the physician is again proven to wield considerable influence over OTC treatment decisions while ensuring appropriate and effective treatment for the consumer throughout his or her overall course of care. For additional insights into consumer OTC purchasing behavior and the role that physicians play in recommending OTCs, AccentHealth s 2014 OTC and VMS white paper will be available on May 5, 2014, via DrugStoreNews.com. Please contact Natalie Hill, VP market research for AccentHealth at nhill@accenthealth. com for questions about the study or to learn how you can leverage AccentHealth s Consumer Connections Panel of more than 8,000 viewers for exclusive insights for your brand. Study findings are derived from a random sample of 150 AccentHealth physicians fielded via Encuity Research, a Campbell Alliance company and 914 AccentHealth viewers from the AccentHealth Consumer Connections Panel. Respondents are stratified geographically across the United States. Symphony Health Solutions ProVoice Survey is the largest healthcare provider survey in the United States, with nearly 60,000 responders annually and provides insights on healthcare providers behaviors across more than 100 OTC categories. COMPLIANCE WITH PHYSICIANS OTC RECOMMENDATIONS Among those consumers who have received an OTC recommendation, 9-in-10 report they typically comply with their doctors suggestions and purchase the OTCs recommended to them. Source: AccentHealth Consumer Connections, 2014 IMPACT OF HEALTHCARE PROVIDER RECOMMENDATIONS ON ANNUAL BRAND SPEND (DIGESTIVE CATEGORY) Promotion (advertising, displays) Healthcare provider recommendation +63% more spend for brands recommended by HCPs Source: Symphony Health Solutions ProVoice Survey: Digestive Health Case Study, April 2012 to May 2013 Powered by 4 APRIL 28, 2014 DRUGSTORENEWS.COM

5 Why Point-of-Care is the new Point-of-Sale. Reach consumers on the path to purchase with a doctor s recommendation. 30,000+ physician waiting rooms which can be geo-targeted CNN produced programming 2x the unaided ad recall vs. broadcast TV* 200MM+ annual Nielsen-verified impressions** 7 out of 10 AccentHealth viewers shop following their doctor s office visit*** *Source: AccentHealth TV Ad Effectiveness Research Norms ( ) **Source: Nielsen 2013 ***Source: MRI 2010, Survey of the AccentHealth Consumer