INFObrief Deloitte 2012 Survey of U.S. Health Care Consumers Rx use and life sciences innovations: Consumers attitudes and behaviors

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1 INFObrief Deloitte 2012 Survey of U.S. Health Care Consumers Rx use and life sciences innovations: Consumers attitudes and behaviors Background This INFOBrief presents key findings about consumers utilization of the U.S. health care system in particular their attitudes and behaviors in relation to life sciences products and services from the Deloitte 2012 Survey of U.S. Health Care Consumers. INFOBriefs also are available on the topics of consumers utilization of health care services; consumers and health information technology; and consumers and health plans. For the full report: 2012 Survey of Health Care Consumers in the United States, 2012 Consumer Study Infographic, Five-Year Look Back, INFOBrief source questions and other INFOBrief reports, visit com/us/consumerstudies. Highlight: At ease with prescription drugs, and looking for knowledge Half of all consumers in 2012 say they currently take prescription medications (Rx). Of those taking medication, 23 percent take one medication, 38 percent take two or three, and 35 percent take four or more. Adherence is high. Consumers feel knowledgeable about the drugs they take and have confidence in their effectiveness. But reported use has declined in recent years among those with chronic conditions, as well as among both the insured and uninsured. The gap in use between the insured and uninsured has widened the insured are now twice as likely as the uninsured to report taking Rx. Rx users actively seek information about treatment effectiveness, costs, side-effects, and alternatives. In an environment where consumers are more actively seeking information, it may be that pharmacists potentially could form a new front line of primary care there is a degree of interest in using pharmacists for this purpose, particularly on the part of younger age groups. Many consumers say they are interested in innovative tests, treatments, and technologies. However, more consumers say they prefer more standard treatments, even if they are less efficacious. Online resources play an important role in providing information to consumers one-half of Rx users look online for treatment information. Trusted sources of information about safety and efficacy of treatments tend to be more traditional health care providers and use of such resources as social media for information is low. Use of smart phone apps for such things as medication reminders is appealing to around one-fourth of consumers.

2 Key Findings: Prescription medication use Consumers confidence with prescription medications is high. But cost concerns lead many to seek generic alternatives, as well as to use home remedies, and over-the-counter products. Figure 1: Prescription medication use, Figure 2: Prescription medication use, confidence and efficacy, % 95% 80% 60% 40% 20% 63% 60% 41% Among the insured, those taking prescription medication decreased from 63 percent in 2008 to 57 percent in 2012 and in the uninsured, from 41 percent in 2008 to 28 percent in Those with chronic conditions who say they take prescription medication dropped from 95 percent in 2008 to 77 percent in Prescription drug use has declined in recent years from 60 percent of the total respondents taking medication in 2008 to 51 percent in % 57% 51% 28% 49% Close to 9 in 10 prescription medication users are highly confident about their medications saying they understand how the medications work, understand 51% risk and side-effects, and believe in the efficacy of the medications. Understand how Rx works Understand risk and side-effects 88% 87% 0% Confident Rx is effective 86% % of those with chronic condition(s) % of insured % of total respondents currently taking prescription medications % of uninsured Percentage shown is those who Strongly Agree or Agree with the statement Those taking Rx Not taking Rx

3 Prescription medication use Consumers confidence with prescription medications is high. But cost concerns lead many to seek generic alternatives, as well as to use home remedies, and over-the-counter products. Figure 3: Adherence to treatment recommendations and medication labels, ,4 Figure 4: Medication switching and adherence among prescription medication users, % 93% 60% 80% 60% 40% 20% 80% 67% 2 in 3 consumers 85% 85% say they 78% generally always follow a 74% 67% doctor s recommended treatment 63% plan. Half of Millennials (51 percent) 51% say they do whereas 85 percent of Seniors do so. Less than half (48 percent) of those without a primary care practitioner say they follow recommended care plans. Seniors (93 percent) 70% are more 72% likely than younger generations to adhere to medication 48% labels but between 6 in 10 and 8 in 10 of those under age 65 years say they take medications as directed. 83% 40% 20% 29% 26% Fewer prescription medication users report switching medications than in previous years. 21% 14% 10% 15% In 2012, 1 in 10 stopped taking their medication early or changed dose/frequency without speaking with their doctor. 10% 15% 11% 0% Total respondents Millennials ( ) Gen X ( ) Boomers ( ) Seniors ( ) Do not have a primary care provider Have a primary care provider 0% Switched Rx N/A Discontinued taking Rx before it was finished N/A N/A Modified dosage or frequency of Rx without asking or telling doctor Aggregate of top third responses (67% to100%) where 100% is almost always ; Almost always follow a treatment plan exactly as the doctor recommends Almost always take prescription medications as directed on the label Percentage of prescription medication users who had done so, in the past year NOTE: For each item, data are shown for the years the question was included in the survey 2009 (n = 2,295 Rx users) 2010 (n = 2,233 Rx users) 2011 (n = 2,261 Rx users) 2012 (n = 2,061 Rx users)

4 Prescription medication use Consumers confidence with prescription medications is high. But cost concerns lead many to seek generic alternatives, as well as to use home remedies, and over-the-counter products. Figure 5: Reasons prescription medication users switched medications, Figure 6: Alternative treatment approaches and natural therapies, ,7 Previous medication did not work or was no longer working for me Previous medication had side effects I did not like Switched to another medication that is easier to take Switched to generic to save money Switched because of insurance-related reasons Switched because of quality or effectiveness Switched because of cost Few consumers switch medications, but those who 12% do, switch in search of better effectiveness (42 percent), due to side-effects (30 percent), and to seek lower cost medications (34 percent). 16% 30% 34% 42% 0% 10% 20% 30% 40% 50% Almost always prefer to take natural remedies versus medicines prescribed in standard medical care Treated a health problem with an alternative approach or natural therapy (e.g., acupuncture, chiropractic, homeopathic, naturopathic, bio-electric) Used an alternative treatment approach or natural therapy in addition to Rx Substituted/used an alternative treatment approach or natural therapy instead of Rx N/A N/A 18% 17% Few use alternative or natural therapies either in substitution 19% for or in addition to prescription medications and this 22% appears to be declining over the years. 18% 9% 16% Nearly 1 in 10 of all 20% respondents in 2012 say they 13% treated a health problem with 7% alternative treatment approaches and natural remedies compared with around 1 in 9% 5 who did so from 2009 to % 8% 7% Percentage of prescription medication users who had done so in the past year 2012 (n = 323 who switched) 0% 10% 20% 30% 40% Percentage who had done so, in the past year 2009 (n = 4,001) 2010 (n = 4,008) 2011 (n = 4,000) 2012 (n = 4,012)

5 Prescription medication use Consumers confidence with prescription medications is high. But cost concerns lead many to seek generic alternatives, as well as to use home remedies, and over-the-counter products. Figure 7: Value-seeking behaviors among prescription medication users, Used home remedies or over-the-counter medicines instead of going to doctor because it was cheaper Purchased generic vs. brand drug because of price information or advice received at pharmacy Asked doctor to prescribe a generic rather than brand drug due to cost Purchased Rx from a mail order or online pharmacy Purchased Rx using a discount card or coupon Purchased over-the-counter (OTC) product from a store instead of filling Rx 35% 34% Prescription medication users show a concern for or sensitivity to cost and many seek cheaper alternatives. 38 percent of those who 22% use prescription medications say they used home remedies or over-the-counter medicines as it was cheaper than visiting the doctor and 35 13% percent purchased a generic drug 1 in 5 based prescription upon a medication pharmacist s users advice. report purchasing their medications through mail order or online pharmacies. Very few say they purchased 9% prescriptions outside of the United States (2 percent). 38% Purchased Rx from a source outside the United States 2% 0% 10% 20% 30% 40% Percentage of prescription medication users who have done so in the past year

6 Prescription medication use Consumers confidence with prescription medications is high. But cost concerns lead many to seek generic alternatives, as well as to use home remedies, and over-the-counter products. Use of vitamins, minerals, and herbal supplements is moderate, with around 6 in 10 currently taking vitamins or minerals for health purposes. On the whole, prescription medication users are slightly more inclined to take vitamins, supplements, and functional food products (food fortified with added or concentrated ingredients to a functional level, intended to improve health and/or performance), for health reasons (Figure 8). Figure 8: Regular use of vitamins, supplements, and/or functional foods for health purposes 8 Respondents Millennials Gen X Baby Boomers Seniors All Rx Users All Rx Users All Rx Users All Rx Users All Rx Users 60% 66% 47% 50% 57% 59% 64% 67% 81% 82% Vitamins or minerals Herbal medicines or supplements 18% 20% 14% 16% 17% 18% 20% 19% 23% 24% 23% 25% 22% 22% 22% 24% 24% 26% 25% 25% Functional foods

7 Trusted sources of information Traditional health care providers are trusted sources of information about effective and safe treatments. Consumers trust health-specific websites more than product manufacturers, health plans, and some government sources. Few consumers use social media for such purposes. Figure 9: Knowledge-related behaviors among prescription medication users, Looked online for information about health problems and/or treatment options 44% 50% 59% 61% Compared available treatment options 20% 15% 33% 33% 1 in 2 Rx users looked online for information. Asked doctor to prescribe a particular drug by name or brand or asked whether it would be better choice 14% 12% 28% 25% 1 in 8 Rx users asked a doctor for a particular product. Asked pharmacist for opinion about Rx prescribed by doctor 17% 24% 26% 25% 1 in 6 Rx users sought a second opinion from a pharmacist. 0% 20% 40% 60% 80% Percentage of prescription medication users who had done so, in the past year 2009 (n = 2,295 Rx users) 2010 (n = 2,233 Rx users) 2011 (n = 2,261 Rx users) 2012 (n = 2,061 Rx users)

8 Trusted sources of information Traditional health care providers are trusted sources of information about effective and safe treatments. Consumers trust health-specific websites more than product manufacturers, health plans, and some government sources. Few consumers use social media for such purposes. Figure 10: Trusted third-party sources for treatment information 9 Trust in sources to provide reliable information on most effective and safe treatment(s) for a certain health condition Physician group/medical practice n/a n/a n/a 44% Academic medical centers/teaching hospitals 50% 41% 47% 38% Medical associations/societies In 2012, consumers say they most trust 51% 45% 45% 37% their physician group/medical practice Community hospitals to provide reliable information about 31% 28% 32% 30% treatment options (44 percent). Pharmacies As in previous years, traditional medical sources such as medical associations and societies and 28% 27% 30% 27% U.S. Department of Health and Human Services (HHS) academic medical centers are highly trusted; however, this percentage fell over the past year: 31% 25% 30% 26% academic medical centers 47 percent in 2011 and Independent health-related websites Health plans, general internet search engines, 28% 22% 27% 24% 38 percent in 2012; medical associations 45 percent bio-pharma/medical device companies, in 2011 and 37 percent in U.S. Food and Drug Administration (FDA) employers, and social media are least 27% 23% 28% 22% State Departments of Health and Human Services preferred Only 14 as percent trusted sources trust Internet of information. search engine results and 5 percent trust social 28% 23% 27% 22% Health insurance companies/health plans networking sites. Independent health-related 13% 10% 14% 14% websites (24 percent) garner nearly Internet search engines/general reference sites as much trust as pharmacies (27 n/a n/a n/a 14% percent) and slightly more trust Pharmaceutical, biotech, or medical device/product manufacturers than the U.S. FDA (22 percent). 11% 9% 10% 12% Employers (e.g., health benefi ts offi ce, human resources offi ce) 10% 9% 12% 12% Blogs or websites that address specifi c health issues or connect people with similar health conditions n/a n/a n/a 11% Social networking sites n/a n/a n/a 5% n/a = not asked ; sorted in descending order for 2012 only. Rating of 8, 9 or 10 on a 10-point scale where 10 is completely trust

9 Trusted sources of information Traditional health care providers are trusted sources of information about effective and safe treatments. Consumers trust health-specific websites more than product manufacturers, health plans, and some government sources. Few consumers use social media for such purposes. Figure 11: Trust of product manufacturers to provide reliable information about treatment effectiveness and safety 10 Figure 12: Use and willingness to use social media and IT tools 11,12 Manufacturers might not share negative information about their products (e.g., potential side effects) 60% Would use a smart phone/tablet app. for medication reminders. 25% Prefer to get this type of information from my doctor Other sources may be more objective in measuring and reporting on effectiveness and safety Information may be too technical and difficult to compare with other products 60 percent of respondents who have low trust in product manufacturers 54% say they are concerned that manufacturers may not disclose essential information about products. Over half of these respondents express 43% a preference for learning about products directly from providers versus researching on their own. 24% Have used social media to learn more about Rx & discuss side effects & alternatives. Have used social media to learn more about a specific illness, injury or health problem 14% Social media and technology tools play an informational role for some consumers with 14 percent turning to social media to learn about medications and side-effects. One- 12% fourth (25 percent) say they would use a smart phone/tablet app for medication reminders. Other sources are in a better position to provide information for comparing treatment options 19% 0% 5% 10% 15% 20% 25% 30% Other 8% 0% 20% 40% 60% 80% n = 3,520 who have a low level of trust in product manufacturers to provide reliable information

10 Innovations and new models of care Pharmacists may form a new front line of primary care as younger consumers seeking information and advice are open to receiving some types of primary care from them. Consumers are open to innovative approaches to care. 56 percent Around say 4 they in 10 would consumers be willing say they to are use videoconferencing interested in using for apps sick that visits; help 67 set percent and would track do health so for improvement follow-up visits. goals. Figure 13: Utilization of pharmacists by generation 5,13,14 27% A pharmacist can provide many 20% of the same services that a primary care provider offers * 21% 14% Used a pharmacist for treatment 22% information or advice for self 14% or family member instead of 10% seeing a doctor (in the past year) Millennials 6% rely on pharmacists more than older generations 1 in 4 believes that pharmacists could provide 20% many primary Asked a pharmacist for their care services and 1 in 5 say they used opinion about a medication 17% that was prescribed by pharmacists to obtain 17% treatment information a doctor (in the past year) or advice instead of a physician. 22% Figure 14: Preference between standard treatment versus innovative treatment 15 34% 28% 33% 34% 1 in 3 consumers would choose an innovative treatment that is less tested but potentially more effective 21% over standard treatment. 26% 32% 30% 28% 33% Would use a medical vending machine to fill a prescription ** 11% 17% 22% 24% 40% 46% 40% Seniors seem to be slightly less certain 38% of the choice between standard versus innovative treatments. 39% 0% 10% 20% 30% 40% * Strongly agree or agree ** Rating of 8, 9. or 10 on a 10-point scale where 10 is extremely likely Millennials ( ) Gen X ( ) Boomers ( ) Seniors ( ) Total Millennials Gen X Boomers Seniors Respondents ( ) ( ) ( ) ( ) Would choose the standard treatment with 75% chance of working No opinion/preference between the two options Would choose the innovative treatment with greater chance of working in early tests, but tested with fewer patients

11 Innovations and new models of care Pharmacists may form a new front line of primary care as younger consumers seeking information and advice are open to receiving some types of primary care from them. Consumers are open to innovative approaches to care. Figure 15: Willingness to take a predictive test; average amount willing to pay 16,17 100% 80% 60% 40% 20% 0% 58% 57% 56% Total Respondents $150 $152 $155 Millennials ( ) Over half of consumers of all ages say they may be interested in taking tests that could predict disease risk, if the test was at no cost. When asked how much they were willing to pay for such a test, those who were willing to take it, say they would pay an average of $150. Gen X ( ) 60% 59% $142 Boomers ( ) Willing to take test predicting likelihood of developing certain health conditions/diseases if test was at no cost Average amount consumers would be willing to pay for the test (among those who are willing to take the test) $159 Seniors ( ) $400 $300 $200 $100 0 Figure 16: Reasons for disinterest in predictive testing 18 38% Test might not be accurate 43% 46% 51% 35% Not interested/prefer not to know my likelihood 42% 41% 46% Concerned that insurance company would drop my 26% Among the 40 percent 35% of respondents who coverage/not accept me if express low or no interest 39% in testing, concern results showed high likelihood about test 25% accuracy and a preference not to know are primary reasons. 16% Already know I am at risk 13% 19% 20% 0% 20% 40% 60% 80% Those who are unwilling/disinterested in taking a predictive test (N=1,688) Millennials ( ) Gen X ( ) Boomers ( ) Seniors ( )

12 Stakeholder considerations Prescription medication users are clearly engaged in managing their care. They look for information, consider alternatives, and seek value and effectiveness. Given the extent of prescription medication use, it is clear that opportunities exist for pharmaceutical manufacturers, providers, and policy makers to plot a course that will reach consumers more effectively. They can develop personalised and targeted products, position themselves as trusted sources of information, provide comparative information on treatment options, and develop strategies to more effectively engage with an active and involved consumer. In particular, they could re-think the business models, brands, marketing, and communication strategies that target upcoming generations, who hold very different expectations from previous generations.. Among important considerations: 1. Active and informed consumers play an increasingly direct role in decision-making regarding their care. Industry stakeholders may tap into this by adding personalized services and systematic customer relationship management to current product-focused strategies. Personalized or targeted pharmaceuticals with companion diagnostics and compliance strategies; precisely targeted markets of sub-segments of the population for personalized products; and, technologyenabled interactions with key customer groups of physicians and consumers are key. 2. Consumer interest in using pharmacists represents a new opportunity to introduce pharmacist-led support programs to optimize adherence and drive up persistence. As a stand-alone delivery channel, opportunities for greater value for pharma companies may be achieved through sales efforts targeted towards pharmacists in addition to or perhaps even instead of to physicians. 3. Health plan benefit design can extend to supporting personalization for individual recipients. The business case for increasing personalization would include patient incentives and levers as well as predictability of outcomes and risk management. Plans can further develop customer-focused market offerings and programs that increase total value. Technological advances through mobile devices and mhealth tools and programs offer health plans the means to achieve value-based personalized outcomes in such things as selfcare programs, remote monitoring, coordinated support programs, reminders for taking prescription drugs or getting lab work done, and so on. Plans may introduce customer communication tools including social media and online communities, on-demand live call center support, click-to-chat support through websites, and mobile sites to further engage consumers.

13 About this research Wellness & healthy living Since 2008, the Deloitte Center for Health Solutions has annually polled a nationally representative sample of the U.S. adult population (up to 4,000 U.S. consumers) about their experiences and attitudes related to six domains. These online surveys have queried adults in varied health status, income, and insurance cohorts to gauge the degree to which individuals are engaging with the health care system as patients or consumers. In 2012, a nationally representative sample of 4,012 U.S. adults, aged 18 and older, was surveyed in February, using a webbased questionnaire. The sampling frame was based upon quotas reflective of the 2010 U.S. Census to ensure proportional representation of the nation s adult population with respect to age, gender, race/ethnicity, income, geography, insurance status (insured or uninsured), and primary insurance source (employer, direct purchase, Medicare, Medicaid, and other).* This marks a change from , when fewer quotas were used and supplemented by cell weighting to achieve a representative sample. In those earlier years, the survey results were weighted with respect to basic demographics (age, gender, race/ethnicity, and income), but not additional variables such as insurance status and source. To achieve even closer sample alignment with insurance status and source distributions in the U.S. population, a more extensive set of quotas was used in 2012 and additional weighting was not necessary to achieve a representative sample. Differences reported in insurance status and source between and 2012 are due largely to this adjustment in sampling. Health policy Consumer Survey: six domains of health care Health insurance Alternative health services The margin of error is +/- 1.6% at the.95 confidence level. The survey consisted of 65 questions addressing specific behaviors and attitudes, with 39 potential follow-up questions and an additional 20 questions asking about demographic and healthrelated characteristics. English and Spanish versions were available. Participants were asked about behaviors before attitudes within each topic area to reduce response bias. Information resources Traditional health services * Source: Quotas for insurance status and insurance source distributions were based on KCMU/Urban Institute analysis of the 2011 ASEC Supplement to the CPS, presented in slides published by the Kaiser Family Foundation (

14 Deloitte Center Contacts for Health Solutions Paul H. Keckley, PhD Executive Director Deloitte Center for Health Solutions Deloitte LLP This publication contains general information only and Deloitte is not, by means of this publication, rendering accounting, business, financial, investment, legal, tax, or other professional advice or services. This publication is not a substitute for such professional advice or services, nor should it be used as a basis for any decision or action that may affect your business. Before making any decision or taking any action that may affect your business, you should consult a qualified professional advisor. Deloitte shall not be responsible for any loss sustained by any person who relies on this publication. Sheryl Coughlin, PhD, MHA Head of Research Deloitte Center for Health Solutions Deloitte LLP scoughlin@deloitte.com Acknowledgements We would also like to thank Laura Eselius, Leslie Korenda, Elizabeth Stanley, Jennifer Bohn, Katrina Drake Hudson, Claire Boozer and the many others who contributed to the preparation of this report. Contact Information Deloitte Center for Health Solutions 1001 G Street N.W. Suite 1200 Washington, DC Phone Fax Toll free healthsolutions@deloitte.com Web at About Deloitte Deloitte refers to one or more of Deloitte Touche Tohmatsu Limited, a UK private company limited by guarantee, and its network of member firms, each of which is a legally separate and independent entity. Please see for a detailed description of the legal structure of Deloitte Touche Tohmatsu Limited and its member firms. Please see for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. Certain services may not be available to attest clients under the rules and regulations of public accounting. About the Center The Deloitte Center for Health Solutions (DCHS) is the health services research arm of Deloitte LLP. Our goal is to inform all stakeholders in the health care system about emerging trends, challenges and opportunities using rigorous research. Through our research, roundtables and other forms of engagement, we seek to be a trusted source for relevant, timely and reliable insights. To learn more about the DCHS, its research projects and events, please visit: Copyright 2012 Deloitte Development LLC. All rights reserved. Member of Deloitte Touche Tohmatsu Limited