CMS-P-0015A Comm2018R81RXQ

Drug Coverage Questionnaire (RXQ)
Variable Name
MR Screen Name

Question type

Question text/description

Code list

RXQ SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C004, C005, C006, C010
SPALIVE=1
SEASON=SUMMER
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer ater IAQ.

BOX RX1

PDXHIDEC

RX1

routing

yes/no

BESIDES MEDICARE, IF TRICARE IS THE ONLY "CURRENT" PLAN, GO TO SC8C - MCAMTPAY
ELSE IF THE RESPONDENT IS A PROXY, GO TO RX1 - PDXHIDEC.
ELSE GO TO RXPD2 - PDEASY.
Do you help (SP) make decisions regarding [his/her] health insurance coverage?

SHOW CARD RX1
Now I have a few questions regarding the Medicare Prescription Drug benefit.
PDEASY

RXPD2

code 1

Overall, how easy or difficult do you think the Medicare Prescription Drug benefit is to understand?
Would you say it is very easy to understand, somewhat easy, somewhat difficult, or very difficult to
understand?

SHOW CARD RX2
How much do you think you know about the Medicare Prescription Drug benefit?
PDKNOW

RXPD3

BOX RXPD2

code1

routing

Do you know just about everything you need to know, most of what you need to know, some of what you
need to know, a little of what you need to know, or almost none of what you need to know about the
Medicare Prescription Drug benefit?

IF SP HAS A "CURRENT" MEDICARE PRESCRIPTION DRUG PLAN, GO TO BOX RXPD3A.
ELSE IF SP HAS A "CURRENT" MEDICARE MANAGED CARE PLAN THAT HAS RX COVERAGE, GO TO RXPD9 PDCONSDR.
ELSE IF SP HAS A "CURRENT" PRIVATE PLAN THAT HAS RX COVERAGE, GO TO RXPD8A - PDCOMPPL.
ELSE GO TO RXPD20 - PDEXAPLY.

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) VERY EASY
(02) SOMEWHAT EASY
(03) SOMEWHAT DIFFICULT
(04) VERY DIFFICULT
(-8) Don't Know
(-9) Refused
(01) JUST ABOUT EVERYTHING YOU
NEED TO KNOW
(02) MOST OF WHAT YOU NEED TO
KNOW
(03) SOME OF WHAT YOU NEED TO
KNOW
(04) A LITTLE OF WHAT YOU NEED TO
KNOW
(05) ALMOST NONE OF WHAT YOU NEED
TO KNOW
(-8) Don't Know
(-9) Refused

[You/(SP)] currently [have/has] drug coverage through [READ PLAN(S) LISTED ABOVE].
PDCOMPPL

RXPD8A

yes/no

Did [you/(SP), or someone for (SP),] compare the (CURRENT YEAR) drug coverage offered by [READ PLAN(S)
LISTED ABOVE] with any Medicare Prescription Drug plans?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

[EXPLAIN IF NECESSARY: A Medicare Prescription Drug plan adds drug coverage to Original Medicare.]
([You/(SP)] currently [have/has] drug coverage through (CURRENT MEDICARE MANAGED CARE PLAN).
Medicare calls this type of plan a Medicare Advantage plan. Medicare also offers separate plans that provide
only drug coverage.)
PDCONSDR

RXPD9

BOX RXPD3

PDMABENS

RXPD10

yes/no

routing

yes/no

BOX RXPD3A

routing

PDEVROLL

RXPD11

yes/no

PDAUTENR

RXPD12

yes/no

PDSWITCH

RXPD14

code 1

PDCOMPRE

RXPD15

yes/no

BOX RXPD4

routing

Did [you/(SP), or someone for (SP),] consider enrolling [her/him] in a separate Medicare Prescription Drug
plan for (CURRENT YEAR)?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

[EXPLAIN IF NECESSARY: A separate Medicare Prescription Drug plan is typically used together with medical
benefits from Original Medicare.]
IF SP HAS A "CURRENT" PRIVATE PLAN THAT HAS RX COVERAGE, GO TO BOX RX2.
ELSE GO TO RXPD10 - PDMABENS.
Did [you/(SP), or someone for (SP),] compare the (CURRENT YEAR) drug coverage offered by [your/his/her]
(CURRENT MEDICARE MANAGED CARE PLAN) plan with any other Medicare Advantage plans in
[your/his/her] area?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

IF SP HAS REPORTED BEING AUTOMATICALLY ENROLLED IN A MEDICARE PRESCRIPTION DRUG PLAN IN ANY
PREVIOUS ROUND, GO TO RXPD12 - PDAUTENR.
ELSE GO TO RXPD11 - PDEVROLL.
Some people were automatically enrolled in a Medicare Prescription Drug plan. By "automatically enrolled", I
(01) YES
mean that the beneficiary was assiged to a plan by Medicare, as opposed to selecting a plan on his or her
(02) NO
own.
(-8) Don't Know
(-9) Refused
[Were you/Was (SP)] ever automatically enrolled in a Medicare Prescription Drug plan?
[Were you/Was (SP)] automatically enrolled in [your/his/her] current Medicare Prescription Drug plan - that
is, [your/his/her] (CURRENT MEDICARE PRESCRIPTION DRUG PLAN) plan?
(01) YES
(02) NO
([EXPLAIN IF NECESSARY: Some people with Medicare were automatically enrolled in a Medicare Prescription (-8) Don't Know
(-9) Refused
Drug plan. By "automatically enrolled," I mean that the beneficiary was assigned to a plan by Medicare as
opposed to selecting a plan on his or her own.])
(01) YES DID KNOW
Before today, did you know that people who are automatically enrolled by Medicare in a Medicare
(02) NO DID NOT KNOW
Prescription Drug plan can switch plans at any time without a penalty?
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
Did [you/(SP), or someone for (SP),] compare (CURRENT YEAR) drug coverage offered by [your/(SP's)
(-8) Don't Know
(CURRENT MEDICARE PRESCRIPTION DRUG PLAN) plan with any other Medicare Prescription Drug plans?
(-9) Refused
IF (RXPD12 - PDAUTENR = 1/Yes) OR (RXPD15 - PDCOMPRE = 2/No, DK, OR RF), GO TO BOX RX2.
ELSE GO TO RXPD18 - PDOPTPRE.

The next questions are about different things [you or (SP)/you] may have thought about when considering
[your/(SP's)] options for (CURRENT YEAR) drug coverage.
PDOPTPRE

RXPD18

list

At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through [(CURRENT MEDICARE
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did you consider [for (SP)]…

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

the cost of the plan's monthly premium?

PDOPTDUC

RXPD18

list

(At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through [(CURRENT MEDICARE
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did you consider [for (SP)]…)
the plan's deductible?

PDOPTFOR

RXPD18

list

(At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through [(CURRENT MEDICARE
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did you consider [for (SP)]…)
the plan's list of covered medicines, or formulary?

PDOPTVEN

RXPD18

list

(At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through [(CURRENT MEDICARE
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did you consider [for (SP)]…)
the convenience of the pharmacies that the plan allows [you(SP)] to use?

PDOPTREC

RXPD18

list

(At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through [(CURRENT MEDICARE
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did you consider [for (SP)]…)
someone's recommendation of the plan?
(At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through [(CURRENT MEDICARE
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did you consider [for (SP)]…)

PDOPTGAP

RXPD18

list

the gap in coverage or "donut hole"?
[EXPLAIN IF NECESSARY: The coverage gap, or "donut hole", is a phase in coverage during which there is a
reduction in coverage and people have to pay a higher share of their drug costs.]

PDOPTPAY

RXPD18

list

(At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through [(CURRENT MEDICARE
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did you consider [for (SP)]…)
the dollar amount [you/(SP)] would pay for prescribed medicines [you use/he uses/she uses]?

BOX RXPD4A

routing

IF RESPONDENT ANSWERED "YES" TO MORE THAN ONE QUESTION AT RXPD18, GO TO RXPD18A PDOPMOST.
ELSE GO TO RXPD18B - PDRECLIS.

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

PDOPMOST

RXPD18A

code 1

Which of these was the most important consideration when [you or (SP)]/you] thought about [your/(SP's)]
options for (CURRENT YEAR) prescription drug coverage?
[READ ITEMS BELOW IF NECESSARY.]

(01) THE COST OF THE PLANS MONTHLY
PREMIUM
(02) THE PLAN'S DEDUCTIBLE
(03) THE PLAN'S LIST OF MEDICINES OR
FORMULARY
(04) CONVENIENCE OF THE PHARMACIES
THAT THE PLAN ALLOWS (SP) TO USE
(05) SOMEONE'S RECOMMENDATION OF
THE PLAN
(06) THE GAP IN COVERAGE OR DONUT
HOLE
(07) THE DOLLAR AMOUNT (SP) WOULD
PAY FOR PRESCRIBED MEDICINES
(-8) Don't Know
(-9) Refused

As you may know, the government has programs that help beneficiaries pay for the costs associated with a
Medicare drug plan and the purchase of prescription drugs. The help provided is referred to as a "lowincome subsidy" or "extra help".
PDRECLIS

RXPD18B

yes/no

[Are you/Is (SP)] receiving this type of help to pay for [your/his/her] (CURRENT YEAR) Medicare prescription
drug coverage?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

[EXPLAIN IF NECESSARY: Beneficiaries who qualify for these programs receive help paying for the Medicare
drug plan's monthly premium, help paying any yearly deductible, help paying coinsurance and copayments
for prescription drugs, and have no coverage gap.]
PDEXAPLY

PDEXACCP

RXINTRO

RXPD20

RXPD21

yes/no

code 1

BOX RX2

routing

RXINTRO

no entry

BOX RX3

routing

(01) YES
(02) NO
Did [you/(SP)] apply to the Social Security Administration for extra help with (CURRENT YEAR) drug coverage?
(-8) Don't Know
(-9) Refused

Was [your/(SP's)] application for extra help accepted or denied?

IF (SP HAS A "CURRENT" MEDICARE PRESCRIPTION DRUG PLAN) OR (IF SP HAS A "CURRENT" MEDICARE
MANAGED CARE PLAN THAT HAS RX COVERAGE) OR (IF SP HAS A "CURRENT" PRIVATE PLAN THAT HAS RX
COVERAGE), GO TO RXINTRO - RXINTRO.
ELSE GO TO RX19 - PDNTENR.
I have a few questions regarding the prescribed drug coverage that [you now receive/(SP) now receives]
through [(CURRENT MEDICARE MANAGED CARE PLAN NAME)/(CURRENT MEDICARE PRESCRIPTION DRUG
PLAN NAME)/(CURRENT PRIVATE PLAN NAMES WITH RX)].
IF (SP HAS A "CURRENT" MEDICARE PRESCRIPTION DRUG PLAN) OR (SP HAS A "CURRENT" MEDICARE
MANAGED CARE PLAN THAT HAS RX COVERAGE), GO TO RXPD23A - PDSATSFY.
ELSE GO TO RX2 - PDCONFID.

(01) ACCEPTED
(02) DENIED
(03) STILL PENDING/NO DECISION YET
(-8) Don't Know
(-9) Refused

(01) CONTINUE
(-7) Empty

PDSATSFY

RXPD23A

code 1

SHOW CARD RX3
At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through ([CURRENT MEDICARE
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], how satisfied were you with the
information that you had to make that decision?

PDCONFID

RX2

code 1

SHOW CARD RX4
How confident are you that [you now have/(SP) now has] the drug coverage that best meets [your/his/her]
needs? Would you say you are…

RXUSEPLN

RX3

yes/no

[Have you/Has (SP)] used [your/his/her] [(CURRENT MEDICARE MANAGED CARE PLAN) drug/(CURRENT
MEDICARE PRESCRIPTION DRUG PLAN NAME)/(CURRENT PRIVATE PLAN NAMES WITH RX)] coverage when
purchasing medicines since January 1 of this year?

RXCOSTLY

RX4

code 1

Compared to last year, is the cost of the monthly premium for [your/(SP's)] [(CURRENT MEDICARE MANAGED
CARE PLAN) drug/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN NAME)/(CURRENT PRIVATE PLAN NAMES
WITH RX)] coverage more, less, or the same?

RXAMNTLY

RX5

code 1

Are the amounts that [you pay/(SP) pays] for medicines at the pharmacy using [your/his/her] [(CURRENT
MEDICARE MANAGED CARE PLAN) drug/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)/(CURRENT
PRIVATE PLAN NAMES WITH RX)] coverage more, less, or the same compared to what [you/he/she] paid last
year?

PDNOCVG

RX7

yes/no

Are there any prescribed medicines that [you regularly take/(SP) regularly takes] that are not covered by
(your/his/her) (CURRENT YEAR) [(CURRENT MEDICARE MANAGED CARE PLAN) drug/(CURRENT MEDICARE
PRESCRIPTION DRUG PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)] coverage?

RXCHGMED

RX8

yes/no

RXSWTCH

RX9

yes/no

RXPARTIC

RX16

code 1

[Have you/Has (SP)] had to change any of [your/his/her] prescribed medicines from a brand name to a
generic medicine because of [your/his/her] (CURRENT YEAR) [(CURRENT MEDICARE MANAGED CARE PLAN)
drug/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)]
coverage?
[Have you/Has (SP)] had to switch to a different medication because a drug [you/he/she] needed was not
available through [your/his/her] (CURRENT YEAR) [(CURRENT MEDICARE MANAGED CARE PLAN)
drug/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)]
coverage?
Does the [(CURRENT MEDICARE MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG
PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)] drug plan network include the pharmacy that [you
generally prefer/(SP) generally prefers] to use?

(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(-8) Don't Know
(-9) Refused
(01) Extremely confident,
(02) Very confident,
(03) Moderately confident,
(04) Slightly confident, or
(05) Not confident?
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) MORE THAN LAST YEAR
(02) LESS THAN LAST YEAR
(03) THE SAME AS LAST YEAR
(04) NO DRUG COVERAGE PREMIUM
LAST YEAR
(-8) Don't Know
(-9) Refused
(01) MORE THAN LAST YEAR
(02) LESS THAN LAST YEAR
(03) THE SAME AS LAST YEAR
(04) NO COST FOR RX LAST YEAR
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

PDRXRATE

RX17

code 1

SHOW CARD RX3
Overall, how satisfied are you with [your/(SP's)] drug plan through [(CURRENT MEDICARE MANAGED CARE
PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)]?

(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(-8) Don't Know
(-9) Refused

PDNOUSE

RX18

code all

(01) HAVE NOT PURCHASED MEDICINE
(02) DON'T HAVE CARD OR OTHER
ENROLLMENT VERIFICATION/NOT ABLE
DUE TO PLAN PROBLEM
Why [haven't you/hasn't (SP)] used [your/his/her] [(CURRENT MEDICARE MANAGED CARE PLAN)/(CURRENT (03) PHARMACY WOULDN'T GIVE
MEDICARE PRESCRIPTION DRUG PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)] coverage in (CURRENT MEDICINE
(04) COST OF RX TOO HIGH/EXPENSIVE
YEAR)?
(05) DRUG(S) NEEDED NOT COVERED BY
CHECK ALL THAT APPLY.
PLAN
(91) OTHER
(-8) Don't Know
(-9) Refused

PDNOOTHOS

RX18

verbatim text

OTHER (SPECIFY)

(01) [Continuous answer.]

(01) HAVE RX COVERAGE THROUGH A
NON-PDP PLAN/SOURCE
(02) DON'T TAKE ENOUGH
PRESCRIPTIONS TO NEED IT
(03) PLANS DON'T COVER
PRESCRIPTIONS SP TAKES
(04) DON'T KNOW HOW TO ENROLL
(05) DON'T KNOW ENOUGH ABOUT
PLANS
(06) TOO EXPENSIVE OR CAN'T AFFORD
(07) TOO CONFUSING OR TOO
COMPLICATED
(08) TOO MANY PLANS TO CHOOSE
FROM OR CAN'T DECIDE ON ONE PLAN
(09) WON'T BENEFIT OR WON'T SAVE
MONEY
(10) HAD A PDP, DIDN'T LIKE IT OR
WASN'T USEFUL
(11) SP BUYS MEDICINE OUTSIDE OF THE
U.S.
(91) OTHER REASON
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]

PDNTENR

RX19

code all

You said that [you are/(SP) is] not enrolled in a Medicare Prescription Drug plan. What is the reason [you
are/he is/she is] not enrolled in such a plan?
CHECK ALL THAT APPLY.

PDNTOTHOS

RX19

verbatim text

OTHER REASON (SPECIFY)

code 1

We are interested in how you feel about [your /(SP)’s] access to prescription drugs during (CURRENT YEAR)]. (01) VERY SATISFIED
(02) SATISFIED
SHOW CARD RX3
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
[Please tell me how satisfied you have been with . . .]
(-8) Don't Know
(-9) Refused
The amount [you have/(SP) has] to pay for [your/(SP's)] prescribed medicines.

MCAMTPAY

SC8C

Some Medicare beneficiaries receive their prescription drug coverage through Medicare Prescription Drug
plans, also called "Medicare Part D" plans.]
DHEVHEAR

SC8G

code one

(01) YES
In many Medicare drug plans there is a coverage gap, sometimes called a "donut hole", during which there is (02) NO
(-8) Don't Know
a reduction in coverage and people have to pay a higher share of their drug costs.
(-9) Refused
Before today, have you heard about the coverage gap or "donut hole" that is part of most Medicare drug
plans?

DHSTART

SC8M

code 1

How did [you/(SP)] first find out that (you/he/she) reached the start of the coverage gap?

(01) SP OR SOMEONE FOR THE SP KEPT
TRACK OF TOTAL MEDICINE SPENDING
(02) INFORMATION PROVIDED BY THE
PART D PLAN
(03) INFORMATION PROVIDED BY THE
PHARMACY
(91)OTHER
(-8) Don't Know
(-9) Refused

DHSTAROS

SC8M

verbatim text

OTHER (SPECIFY)

(01) [Continuous answer.]

[Have you/Has (SP)] reached the end of the coverage gap during [CURRENT YEAR]?

DHEND

DHWORRY

SC8N

SC8O

yes/no

code 1

(01) YES
[EXPLAIN IF NECESSARY: If [you have/(SP) has] reached the end of the coverage gap, it means (you have/he
(02) NO
has/she has) reached a phase in coverage when [you pay/(he/she) pays] a small percentage of the total cost
(-8) Don't Know
of each prescription and (your/his/her) drug plan pays the remaining amount.]
(-9) Refused
REFER TO THE MOST RECENT MEDICARE PRESCRIPTION DRUG PLAN STATEMENT TO HELP THE RESPONDENT
VERIFY THIS INFORMATION.
For (CURRENT YEAR), how worried (are/is/were/was) [you/(SP)] about [your/his/her] ability to pay for
[your/his/her] medicines during the coverage gap?
Would you say that [you/(SP)] [are/is/were/was] very worried, somewhat worried, or not at all worried?

BOX SC1A

routing

IF (SP HAD PRESCRIPTION DRUG COVERAGE ANYTIME IN THE CURRENT ROUND (MCDRXCOV=1/Yes or
TRIRXCOV=1/Yes or PUBRXCOV=1/Yes or PRVRXCOV=1/Yes or MHMORX=1/Yes)) OR (SP IS COVERED BY A
MEDICARE PRESCRIPTION DRUG PLAN (PLANTYPE = 7) ANYTIME IN THE CURRENT ROUND), GO TO SC8D MCDRGLST.
ELSE GO TO SC20-GENERRX.
SHOW CARD RX3
[Please tell me how satisfied you have been with . . .]

MCDRGLST

SC8D

code 1

[Your/(SP's)] prescription drug plan's formulary or the list of drugs covered by the plan.
[EXPLAIN IF NECESSARY: By prescription drug plan, we mean any health insurance plan that provides drug
coverage.]

(01) VERY WORRIED
(02) SOMEWHAT WORRIED
(03) NOT AT ALL WORRIED
(-8) Don't Know
(-9) Refused

(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused

SHOW CARD RX3
[Please tell me how satisfied you have been with . . .]
MCFNDPCY

SC8E

code 1

The ease of finding a pharmacy which accepts your prescription drug plan.
[EXPLAIN IF NECESSARY: By prescription drug plan, we mean any health insurance plan that provides drug
coverage.]
Would [you/(SP)] recommend [your/his/her] prescription drug plan to other people like [you/him/her]?

MCRECPLN

SC8F

code 1

[EXPLAIN IF NECESSARY: By prescription drug plan, we mean any health insurance plan that provides your
drug coverage.]
SHOW CARD RX5

GENERRX

SC20

list

Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things.
[Have you/has (SP)] often, sometimes, or never…
asked for generics instead of brand name drugs?
SHOW CARD RX5

MAILRX

SC20

list

[Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things.
Have you/has (SP)] often, sometimes, or never… ]
purchased prescription drugs through the mail or on the Internet?
SHOW CARD RX5

DOSESRX

SC20

list

SKIPRX

SC20

list

DELAYRX

SC20

list

SAMPLERX

SC21

list

(01) VERY SATISFIED
(02) SATISFIED
(03) DISSATISFIED
(04) VERY DISSATISFIED
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
(01) OFTEN
(02) SOMETIMES
(03) NEVER
(04) AUTOMATICALLY RECEIVES
GENERICS
(-8) Don't Know
(-9) Refused
(01) OFTEN
(02) SOMETIMES
(03) NEVER
(-8) Don't Know
(-9) Refused

(01) OFTEN
(02) SOMETIMES
[Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things. Have
(03) NEVER
you/has (SP)] often, sometimes, or never… ]
(-8) Don't Know
(-9) Refused
taken smaller doses than prescribed of a medicine to make the medicine last longer?
SHOW CARD RX5
(01) OFTEN
(02) SOMETIMES
[Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things.Have
(03) NEVER
you/has (SP)] often, sometimes, or never…]
(-8) Don't Know
(-9) Refused
skipped doses to make the medicine last longer?
SHOW CARD RX5
(01) OFTEN
[Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things. Have (02) SOMETIMES
you/has (SP)] often, sometimes, or never…]
(03) NEVER
(-8) Don't Know
delayed getting a prescription filled because the medicine cost too much?
(-9) Refused
SHOW CARD RX5
(01) OFTEN
(02) SOMETIMES
[Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things. Have
(03) NEVER
you/has (SP)] often, sometimes, or never…]
(-8) Don't Know
(-9) Refused
asked for or received free samples from (your/his/her) doctor or health professional?

SHOW CARD RX5
COMPARRX

SC21

list

NOFILLRX

SC21

list

(01) OFTEN
(02) SOMETIMES
[Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things. Have
(03) NEVER
you/has (SP)] often, sometimes, or never…]
(-8) Don't Know
(-9) Refused
compared prices or shopped around for the best price?
SHOW CARD RX5
(01) OFTEN
(02) SOMETIMES
[Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things. Have
(03) NEVER
you/has (SP)] often, sometimes, or never…]
(-8) Don't Know
(-9) Refused
decided not to fill a prescription because it cost too much?
SHOW CARD RX5

SPENTLRX

SC21

list

(01) OFTEN
(02) SOMETIMES
[Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things. Have
(03) NEVER
you/has (SP)] often, sometimes, or never…]
(-8) Don't Know
(-9) Refused
spent less money on food, heat, or other basic needs so that (you/he/she) would have money for medicine?
SHOW CARD RX5

CHAINRX

SC22

list

STOPRX

SC22

list

CREDRX

SC22

list

NOINSRX

SC23

code 1

(01) OFTEN
(02) SOMETIMES
[Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things.Have
(03) NEVER
you/has (SP)] often, sometimes, or never…]
(-8) Don't Know
(-9) Refused
purchased prescription drugs from a large retail chain, like Wal-Mart or Target, because of its discount plan?
SHOW CARD RX5
(01) OFTEN
[Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things. Have
(02) SOMETIMES
you/has (SP)] often, sometimes, or never…]
(03) NEVER
(-8) Don't Know
talked with (your/his/her) doctor or other health professional about stopping a medicine to save money or
(-9) Refused
substituting a medicine with one that is less expensive?
SHOW CARD RX5
(01) OFTEN
(02) SOMETIMES
[Please tell me how often during (CURRENT YEAR) [you have /(SP) has] done any of the following things.
(03) NEVER
[Have you/has (SP)] often, sometimes, or never…]
(-8) Don't Know
(-9) Refused
used a credit card so that (you/he/she) could pay for prescription drugs over time?
SHOW CARD RX5
Some pharmacies offer discounted prices for some generic prescription drugs that are lower than a typical
insurance copayment. For example, the discounted price may be $4 to fill a one-month prescription.
Please tell me how often during (CURRENT YEAR) [you have /(SP) has] purchased discounted prescription
drugs, without using any drug insurance, in order to reduce (your/his/her) own spending on drugs?

BOX RXEND

routing

IF INTTYPE in(C001, C002, C004, C005, C006, C010) GO TO END.

(01) OFTEN
(02) SOMETIMES
(03) NEVER
(-8) Don't Know
(-9) Refused