Patient #2 Survey Completes

Sample Initial Patient Invitation Letter with Instructions How to Participate

«Date»

«First Name» «Last Name»

«Address1» «Address2»

«City», «State» «Zip Code»

Dear «First Name» «Last Name»:

UnitedHealthcare works with physicians and scientific researchers to provide information to enhance the quality of health care delivery. To that end, UnitedHealthcare sometimes asks members if they would like to participate in research. We are writing to ask if you would like to participate in a research study focused on patients’ perspectives on the appearance of prescription medications. We are working with a team of physicians and researchers at Harvard Medical School and Brigham and Women’s Hospital on this study which is funded by the Food and Drug Administration. The findings of this survey will be important in clarifying our understanding of patients’ views in this area, and will guide future programs at the Food and Drug Administration aimed to promote positive outcomes among patients like you.

You were randomly chosen from a list of adult UnitedHealthcare members who have been prescribed a generic drug in the last few months. If you have never received a prescription for a generic drug, please disregard this letter. If you have, please consider participating in this survey.

This survey includes questions about your experiences with receiving a prescription drug during a routine refill that has changed in appearance, questions about whether your pharmacist notified you of the change, and general questions about you. It may take up to 20 minutes to complete the survey. To thank you for your time and consideration, Optum has included $5.00 which you may keep whether or not you decide to participate in the survey. You will receive a $20.00 Amazon gift card once we receive your completed survey. In order to qualify for the payment, we must receive your completed survey either by mail or online by <survey end date>.

The study is being conducted by Optum, which is affiliated with UnitedHealthcare, and is sponsored by the Brigham and Women’s Hospital in collaboration with the Food and Drug Administration. Optum was required by law to obtain approval from an Institutional Review Board and Privacy Board to conduct the study and to access your information in order to send you this invitation. Optum has contracted with ANA Research (ANA), a professional survey research company, to conduct the survey.

Your participation in this study is completely voluntary. Participation or refusal to participate in this study will not affect your access to health care benefits in any way. Optum will treat the information you provide as strictly confidential, and it will only be used for the purposes of this study. We will not use your name when we share the study results. Please read more about the study in the informed consent statement enclosed.

By responding to the survey either on paper or online, you are agreeing to participate in the study. To participate in the study, complete the survey by following the instructions contained in the enclosed survey packet. After you fill out your survey completely, you may mail it to ANA using the postage-paid envelope provided.

To complete the survey online, enter the information below in the appropriate field on the secure website: [Website address].

Your unique password is: [Password]

If you have any questions regarding the study, please call the Optum Epidemiology Research Associate, Laura Pierce, toll-free at 1-855-272-2876. If you have questions about the prevention or treatment of any disease, or if you experience any health problems during the study, please contact your doctor directly. Your primary doctor on record with UnitedHealthcare will be notified of this study invitation but will not see any information you provide unless you share this information with him or her.

If you do not wish to participate in this study, please disregard this letter and the survey, and any future communications you may receive about the study.

Thank you in advance for your help with this important research.

Sincerely,

/s/ /s/

Richard A. Justman, MD David Dore, PharmD, PhD

National Medical Director Vice President, Epidemiology

UnitedHealthcare Optum

NEIRB #

OMB No.

«Study ID»

DRG#: SR11069024

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