CMS-P-0015A Drug Coverage

2019 MCBS Community Questionnaire

Variable Name

MR Screen Name

RXQ - DRUG COVERAGE

Question Type

Question Text/Description

Code List

Routing

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

(01) RXPD2 - PDEASY
(02) SC8C - MCAMTPAY
(-8) SC8C - MCAMTPAY
(-9) MCAMTPAY

(01) VERY EASY
(02) SOMEWHAT EASY
(03) SOMEWHAT DIFFICULT
(04) VERY DIFFICULT
(-8) Don't Know
(-9) Refused

RXPD3 - PDKNOW

DRUG COVERAGE QUESTIONNAIRE 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?

code1

(01) JUST ABOUT EVERYTHING YOU NEED TO
KNOW
(02) MOST OF WHAT YOU NEED TO KNOW
(03) SOME OF WHAT YOU NEED TO KNOW
Do you know just about everything you need to know, most of what you need to know, some of what you need to (04) A LITTLE OF WHAT YOU NEED TO KNOW
know, a little of what you need to know, or almost none of what you need to know about the Medicare
(05) ALMOST NONE OF WHAT YOU NEED TO KNOW
Prescription Drug benefit?
(-8) Don't Know
(-9) Refused

routing

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.

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

RXPD3

BOX RXPD2

[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?
[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

BOX RXPD2

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

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

BOX RXPD3

routing

IF SP HAS A "CURRENT" PRIVATE PLAN THAT HAS RX COVERAGE, GO TO BOX RX2.
ELSE GO TO RXPD10 - PDMABENS.

RXPD10

yes/no

(01) YES
Did [you/(SP), or someone for (SP),] compare the (CURRENT YEAR) drug coverage offered by [your/his/her]
(02) NO
(CURRENT MEDICARE MANAGED CARE PLAN) plan with any other Medicare Advantage plans in [your/his/her]
(-8) Don't Know
area?
(-9) Refused

BOX RXPD4

BOX RXPD3A

routing

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.

RXPD9

yes/no

Did [you/(SP), or someone for (SP),] consider enrolling [her/him] in a separate Medicare Prescription Drug plan
for (CURRENT YEAR)?
[EXPLAIN IF NECESSARY: A separate Medicare Prescription Drug plan is typically used together with medical
benefits from Original Medicare.]

BOX RXPD3

PDMABENS

Page 1 of 7

2019 MCBS Community Questionnaire

Variable Name

PDEVROLL

MR Screen Name

RXPD11

RXQ - DRUG COVERAGE

Question Type

yes/no

Question Text/Description

Code List

Routing

Some people were automatically enrolled in a Medicare Prescription Drug plan. By "automatically enrolled", I
mean that the beneficiary was assiged to a plan by Medicare, as opposed to selecting a plan on his or her own.

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

(01) RXPD12 - PDAUTENR
(02) RXPD15 - PDCOMPRE
(-8) RXPD15 - PDCOMPRE
(-9) RXPD15 - PDCOMPRE

[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?
PDAUTENR

PDSWITCH

PDCOMPRE

RXPD12

yes/no

(01) YES
(02) NO
([EXPLAIN IF NECESSARY: Some people with Medicare were automatically enrolled in a Medicare Prescription (-8) Don't Know
Drug plan. By "automatically enrolled," I mean that the beneficiary was assigned to a plan by Medicare as
(-9) Refused
opposed to selecting a plan on his or her own.])

code 1

Before today, did you know that people who are automatically enrolled by Medicare in a Medicare Prescription
Drug plan can switch plans at any time without a penalty?

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

RXPD15 - PDCOMPRE

RXPD15

yes/no

Did [you/(SP), or someone for (SP),] compare (CURRENT YEAR) drug coverage offered by [your/(SP's)
(CURRENT MEDICARE PRESCRIPTION DRUG PLAN) plan with any other Medicare Prescription Drug plans?

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

BOX RXPD4

BOX RXPD4

routing

IF (RXPD12 - PDAUTENR = 1/Yes) OR (RXPD15 - PDCOMPRE = 2/No, DK, OR RF), GO TO BOX RX2.
ELSE GO TO RXPD18 - PDOPTPRE.

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

RXPD18 - PDOPTDUC

list

(At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through [(CURRENT MEDICARE (01) YES
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did you consider [for (SP)]…) (02) NO
(-8) Don't Know
the plan's deductible?
(-9) Refused

RXPD18 - PDOPTFOR

list

(At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through [(CURRENT MEDICARE (01) YES
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did you consider [for (SP)]…) (02) NO
(-8) Don't Know
the plan's list of covered medicines, or formulary?
(-9) Refused

RXPD18 - PDOPTVEN

list

(At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through [(CURRENT MEDICARE (01) YES
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did you consider [for (SP)]…) (02) NO
(-8) Don't Know
the convenience of the pharmacies that the plan allows [you(SP)] to use?
(-9) Refused

RXPD18 - PDOPTREC

list

(At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through [(CURRENT MEDICARE (01) YES
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did you consider [for (SP)]…) (02) NO
(-8) Don't Know
someone's recommendation of the plan?
(-9) Refused

RXPD18 - PDOPTGAP

RXPD14

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

RXPD14 - PDSWITCH

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 cost of the plan's monthly premium?

PDOPTDUC

PDOPTFOR

PDOPTVEN

PDOPTREC

RXPD18

RXPD18

RXPD18

RXPD18

(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.]

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

RXPD18 - PDOPTPAY

Page 2 of 7

2019 MCBS Community Questionnaire

Variable Name

PDOPTPAY

PDOPMOST

MR Screen Name

RXQ - DRUG COVERAGE

Question Type

Question Text/Description

RXPD18

list

(At the time that [you/(SP)] decided to have (CURRENT YEAR) drug coverage through [(CURRENT MEDICARE (01) YES
MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)], did you consider [for (SP)]…) (02) NO
(-8) Don't Know
the dollar amount [you/(SP)] would pay for prescribed medicines [you use/he uses/she uses]?
(-9) Refused

BOX RXPD4A

routing

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

code 1

(01) THE COST OF THE PLANS MONTHLY PREMIUM
(02) THE PLAN'S DEDUCTIBLE
(03) THE PLAN'S LIST OF MEDICINES OR
FORMULARY
Which of these was the most important consideration when [you or (SP)]/you] thought about [your/(SP's)] options (04) CONVENIENCE OF THE PHARMACIES THAT THE
for (CURRENT YEAR) prescription drug coverage?
PLAN ALLOWS (SP) TO USE
RXPD18B - PDRECLIS
(05) SOMEONE'S RECOMMENDATION OF THE PLAN
[READ ITEMS BELOW IF NECESSARY.]
(06) THE GAP IN COVERAGE OR DONUT HOLE
(07) THE DOLLAR AMOUNT (SP) WOULD PAY FOR
PRESCRIBED MEDICINES
(-8) Don't Know
(-9) Refused

RXPD18A

Code List

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 "low-income
subsidy" or "extra help".

PDRECLIS

PDEXAPLY

PDEXACCP

RXINTRO

PDSATSFY

Routing

BOX RXPD4A

(01) YES
[Are you/Is (SP)] receiving this type of help to pay for [your/his/her] (CURRENT YEAR) Medicare prescription drug (02) NO
coverage?
(-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.]

(01) BOX RX2
(02) RXPD20 - PDEXAPLY
(-8) RXPD20 - PDEXAPLY
(-9) RXPD20 - PDEXAPLY

Did [you/(SP)] apply to the Social Security Administration for extra help with (CURRENT YEAR) drug coverage?

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

(01) RXPD21 - PDEXACCP
(02) BOX RX2
(-8) BOX RX2
(-9) BOX RX2

code 1

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

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

BOX RX2

BOX RX2

routing

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.

RXINTRO

no entry

I have a few questions regarding the prescribed drug coverage that [you now receive/(SP) now receives] through
(01) CONTINUE
[(CURRENT MEDICARE MANAGED CARE PLAN NAME)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN
(-7) Empty
NAME)/(CURRENT PRIVATE PLAN NAMES WITH RX)].

BOX RX3

routing

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.

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?

RXPD18B

RXPD20

RXPD21

RXPD23A

yes/no

yes/no

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

BOX RX3

RX2 - PDCONFID

Page 3 of 7

2019 MCBS Community Questionnaire

Variable Name

PDCONFID

RXUSEPLN

RXCOSTLY

RXAMNTLY

MR Screen Name

RX2

RX3

RX4

RX5

RXQ - DRUG COVERAGE

Question Type

Question Text/Description

code 1

(01) Extremely confident,
(02) Very confident,
SHOW CARD RX4
(03) Moderately confident,
How confident are you that [you now have/(SP) now has] the drug coverage that best meets [your/his/her] needs? (04) Slightly confident, or
Would you say you are…
(05) Not confident?
(-8) Don't Know
(-9) Refused

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?

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

(01) RX4 - RXCOSTLY
(02) RX18 - PDNOUSE
(-8) RX18 - PDNOUSE
(-9) RX18 - PDNOUSE

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?

(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

RX5 - RXAMNTLY

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?

(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

RX7 - PDNOCVG

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?

PDNOCVG

RX7

yes/no

RXCHGMED

RX8

yes/no

RXSWTCH

RX9

yes/no

RXPARTIC

RX16

code 1

PDRXRATE

RX17

code 1

Code List

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[Have you/Has (SP)] had to change any of [your/his/her] prescribed medicines from a brand name to a generic
(01) YES
medicine because of [your/his/her] (CURRENT YEAR) [(CURRENT MEDICARE MANAGED CARE PLAN)
(02) NO
drug/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)]
(-8) Don't Know
(-9) Refused
coverage?
[Have you/Has (SP)] had to switch to a different medication because a drug [you/he/she] needed was not
(01) YES
available through [your/his/her] (CURRENT YEAR) [(CURRENT MEDICARE MANAGED CARE PLAN)
(02) NO
drug/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)]
(-8) Don't Know
(-9) Refused
coverage?
(01) YES
Does the [(CURRENT MEDICARE MANAGED CARE PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG
(02) NO
PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)] drug plan network include the pharmacy that [you
(-8) Don't Know
generally prefer/(SP) generally prefers] to use?
(-9) Refused
(01) VERY SATISFIED
(02) SATISFIED
SHOW CARD RX3
(03) DISSATISFIED
Overall, how satisfied are you with [your/(SP's)] drug plan through [(CURRENT MEDICARE MANAGED CARE
(04) VERY DISSATISFIED
PLAN)/(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)]?
(-8) Don't Know
(-9) Refused

Routing

RX3 - RXUSEPLN

RX8 - RXCHGMED

RX9 - RXSWTCH

RX16 - RXPARTIC

RX17 - PDRXRATE

SC8C - MCAMTPAY

(01) HAVE NOT PURCHASED MEDICINE
(02) DON'T HAVE CARD OR OTHER ENROLLMENT
VERIFICATION/NOT ABLE DUE TO PLAN PROBLEM
(03) PHARMACY WOULDN'T GIVE MEDICINE
(04) COST OF RX TOO HIGH/EXPENSIVE
(05) DRUG(S) NEEDED NOT COVERED BY PLAN
(91) OTHER
(-8) Don't Know
(-9) Refused

(01) SC8C - MCAMTPAY
(02) SC8C - MCAMTPAY
(03) SC8C - MCAMTPAY
(04) SC8C - MCAMTPAY
(05) SC8C - MCAMTPAY
(91) RX18 - PDNOOTHOS
(-8) SC8C - MCAMTPAY
(-9) SC8C - MCAMTPAY

PDNOUSE

RX18

code all

Why [haven't you/hasn't (SP)] used [your/his/her] [(CURRENT MEDICARE MANAGED CARE PLAN)/(CURRENT
MEDICARE PRESCRIPTION DRUG PLAN)/(CURRENT PRIVATE PLAN NAMES WITH RX)] coverage in
(CURRENT YEAR)?
CHECK ALL THAT APPLY.

PDNOOTHOS

RX18

verbatim text

OTHER (SPECIFY)

(01) [Continuous answer.]

SC8C - MCAMTPAY

(01) SC8C - MCAMTPAY
(02) SC8C - MCAMTPAY
(03) SC8C - MCAMTPAY
(04) SC8C - MCAMTPAY
(05) SC8C - MCAMTPAY
(06) SC8C - MCAMTPAY
(07) SC8C - MCAMTPAY
(08) SC8C - MCAMTPAY
(09) SC8C - MCAMTPAY
(10) SC8C - MCAMTPAY
(11) SC8C - MCAMTPAY
(91) RX19 - PDNTOTHOS
(-8) SC8C - MCAMTPAY
(-9) SC8C - MCAMTPAY

SC8C - MCAMTPAY

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.

(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

PDNTOTHOS

RX19

verbatim text

OTHER REASON (SPECIFY)

(01) [Continuous answer.]

Page 4 of 7

2019 MCBS Community Questionnaire

Variable Name

MCAMTPAY

MR Screen Name

SC8C

RXQ - DRUG COVERAGE

Question Type

code 1

Question Text/Description

Code List

Routing

We are interested in how you feel about [your /(SP)’s] access to prescription drugs during (CURRENT YEAR)].

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

BOX SC1AA

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

SC81- DHPLAN

SHOW CARD RX3
[Please tell me how satisfied you have been with . . .]
The amount [you have/(SP) has] to pay for [your/(SP's)] prescribed medicines.

BOX SC1AA

routing

IF (SP HAS A "CURRENT" MEDICARE PRESCRIPTION DRUG PLAN) OR (SP HAS A "CURRENT" MEDICARE
ADVANTAGE PLAN THAT HAS RX COVERAGE), GO TO SC8G- DHEVHEAR
ELSE GO TO BOX SC1A

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

SC8G

code one

In many Medicare drug plans there is a coverage gap, sometimes called a "donut hole", during which there is a
reduction in coverage and people have to pay a higher share of their drug costs.
Before today, have you heard about the coverage gap or "donut hole" that is part of most Medicare drug plans?

DHPLAN

SC8I

yes/no

Does [your/(SP's)] [(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)/(CURRENT MEDICARE
ADVANTAGE PLAN)] plan have a coverage gap, or “doughnut hole”?

(01) YES
(02) NO
(-8) Don't Know
[EXPLAIN IF NECESSARY: The coverage gap, or "doughnut hole", is a phase in coverage during which there is
(-9) Refused
a reduction in coverage and people have to pay a higher share of their drug costs.]

(01) SC8L - DHTHISYR
(02) BOX SC1A
(-8) BOX SC1A
(-9) BOX SC1A

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

SC8L

yes/no

[EXPLAIN IF NECESSARY: If [you have/(SP) has] reached the start of the coverage gap, it means [you have/he
has/she has] reached a phase during which there is a reduction in coverage and [you/he/she] will have to pay a
higher share of [your/his/her] drug costs.]
REFER TO THE MOST RECENT MEDICARE PRESCRIPTION DRUG PLAN STATEMENT TO HELP THE
RESPONDENT VERIFY THIS INFORMATION.

DHSTART

SC8M

code 1

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

DHSTAROS

SC8M

verbatim text

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

DHEND

DHWORRY

SC8N

SC8O

yes/no

code 1

[EXPLAIN IF NECESSARY: If [you have/(SP) has] reached the end of the coverage gap, it means (you have/he
has/she has) reached a phase in coverage when [you pay/(he/she) pays] a small percentage of the total cost of
each prescription and (your/his/her) drug plan pays the remaining amount.]
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

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

(01) SC8M - DHSTART
(02) BOX SC1A
(-8) BOX SC1A
(-9) BOX SC1A

(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

(01) SC8N - DHEND
(02) SC8N - DHEND
(03) SC8N - DHEND
(91) SC8M - DHSTAROS
(-8) SC8N - DHEND
(-9) SC8N - DHEND

(01) [Continuous answer.]

SC8N - DHEND

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

(01) SC8O - DHWORRY
(02) SC8O - DHWORRY
(-8) BOX SC1A
(-9) BOX SC1A

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

BOX SC1A

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.

Page 5 of 7

2019 MCBS Community Questionnaire

Variable Name

MR Screen Name

RXQ - DRUG COVERAGE

Question Type

Question Text/Description
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.]

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.]

Code List

Routing

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

SC8E - MCFNDPCY

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

SC8F - MCRECPLN

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

SC20 - GENERRX

SHOW CARD RX5
GENERRX

SC20

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…
(04) AUTOMATICALLY RECEIVES GENERICS
(-8) Don't Know
asked for generics instead of brand name drugs?
(-9) Refused

SC20 - MAILRX

SHOW CARD RX5
MAILRX

SC20

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
purchased prescription drugs through the mail or on the Internet?

SHOW CARD RX5
DOSESRX

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… ]
taken smaller doses than prescribed of a medicine to make the medicine last longer?
SHOW CARD RX5

SKIPRX

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…]
skipped doses to make the medicine last longer?

DELAYRX

SC20

list

SHOW CARD RX5
[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…]
delayed getting a prescription filled because the medicine cost too much?

SHOW CARD RX5
SAMPLERX

SC21

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 or received free samples from (your/his/her) doctor or health professional?
SHOW CARD RX5

COMPARRX

SC21

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…]
compared prices or shopped around for the best price?

SC20 - DOSESRX

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

SC20 - SKIPRX

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

SC20 - DELAYRX

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

SC21 - SAMPLERX

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

SC21 - COMPARRX

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

SC21 - NOFILLRX

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2019 MCBS Community Questionnaire

Variable Name

MR Screen Name

RXQ - DRUG COVERAGE

Question Type

Question Text/Description
SHOW CARD RX5

NOFILLRX

SC21

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…]
decided not to fill a prescription because it cost too much?

SHOW CARD RX5
SPENTLRX

SC21

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…]
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

[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 from a large retail chain, like Wal-Mart or Target, because of its discount plan?

STOPRX

SC22

list

SHOW CARD RX5
[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…]
talked with (your/his/her) doctor or other health professional about stopping a medicine to save money or
substituting a medicine with one that is less expensive?

Code List

Routing

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

SC21 - SPENTLRX

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

SC22 - CHAINRX

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

SC22 - STOPRX

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

SC22 - CREDRX

SHOW CARD RX5
CREDRX

NOINSRX

SC22

SC23

list

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
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

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

SC23 - NOINSRX

BOX RXEND

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

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