Pharmacy Satisfaction Survey Script_3.30.22

Pharmacy Program Satisfaction Survey Script

RCS: DD-HA-2640
Expires: X/XX/XXXX
OMB Control Number: 0704-0553
Expiration Date: XX/XX/XXXX

AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, 0704-0553, is estimated to
average 10 minutes per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. Send comments regarding the burden estimate or burden reduction
suggestions to the Department of Defense, Washington Headquarters Services, at [email protected]. Respondents should be aware that
notwithstanding any other provision of law, no person shall be subject to any penalty for failing
to comply with a collection of information if it does not display a currently valid OMB control
number.

A: Hello, I’m _________ calling from Zogby Analytics, a research company conducting a survey for the
Department of Defense TRICARE Program. May I please speak with (insert name of respondent)?
If yes  Go to B
If no  “Do you know when (Rank, Mr. or Ms. and Name) will be available?”
i.
If no time is given or they don’t know  “Thank you for your time. I will
call back later.”
ii.
If a time is given  “Thank you for your time. I will call back then.”
iii.
No such person Thank you and terminate the interview
iv.
Refused  Thank you and terminate the interview
For Interviewer Only
Interviewer code -- Reason the sample member is not available

Deceased

Incapacitated

Deployed and not available

Temporarily unavailable, such as on vacation or on a business trip

Relocated, new location unknown

Incarcerated

Refused call
B: Great. To start, I’d like to assure you that I am not selling anything. The purpose of this survey is to
collect information about beneficiary experiences with having prescriptions filled at a military pharmacy.
This survey asks questions about how satisfied you are with various aspects of having your prescription
filled and will be used to help TRICARE assess the pharmacy program. The survey takes less than 10
minutes.
Participation in this survey is voluntary; you may ask to skip any question that you do not want to
answer and you can stop at any time. There is no penalty if you choose not to be in the survey; however,
we hope that you will participate so that our report will be complete. Your answers will be confidential,
and any identifying information will be used only by the research team. Your name and any identifying
information will be removed from your responses so individuals collecting information from this survey

will only see your answers and not your name. If during this survey you threaten to harm yourself or
others we are required to notify appropriate authorities for action.
Do you have a few minutes?
Yes  proceed to Q1
No  “Is there a time that would work better?”
If a time is given, then “Thank you for your time, we will call back then.”
If respondent refuses  then thank and terminate
Refuse  thank and terminate
As I mentioned, this survey is about your experiences in having a prescription filled at a military
pharmacy in the last [specified time frame] months. To start, I’d like to ask a few questions about
whether your pharmacy had your medication in stock when you needed it.
1. How satisfied were you with the pharmacy’s having your medication in stock when you needed
it? Would you say you are…
a. Very satisfied
b. Somewhat satisfied
c. Neither dissatisfied nor satisfied
d. Somewhat dissatisfied
e. Very dissatisfied
[Dissatisfied respondents only (response choices d and e)] Please describe why you were
dissatisfied with the pharmacy’s having your medication in stock. [OPEN-ENDED]
2. How satisfied were you with the length of time it took the military pharmacy to fill your
prescription? Would you say you are…
a. Very satisfied
b. Somewhat satisfied
c. Neither dissatisfied nor satisfied
d. Somewhat dissatisfied
e. Very dissatisfied
[Dissatisfied respondents only (response choices d and e)] Please describe why you were
dissatisfied with the length of time it took to fill your prescription. [OPEN-ENDED]
3. How satisfied were you with the accuracy with which the pharmacy filled your prescription?
Would you say you are…
a. Very satisfied
b. Somewhat satisfied
c. Neither dissatisfied nor satisfied
d. Somewhat dissatisfied
e. Very dissatisfied
[Dissatisfied respondents only (response choices d and e)] Please describe why you were
dissatisfied with the accuracy of your prescription. [OPEN-ENDED],

4. All things considered, how satisfied are you with the military pharmacy's service in providing
your pharmacy benefit? Would you say you are…
a. Very satisfied
b. Somewhat satisfied
c. Neither dissatisfied nor satisfied
d. Somewhat dissatisfied
e. Very dissatisfied
[Dissatisfied respondents only (response choices d and e)] Could you please explain why you
are dissatisfied with the military pharmacy’s service? [OPEN-ENDED]
5. Using any number from 0 to 10, where 0 is the worst service possible and 10 is the best service
possible, what number would you use to rate your satisfaction with the service you received
under in having your prescription filled? [Interviewer: Don’t read responses]
0
1
2
3
4
5
6
7
8
9
10

6. Thank you for sharing your opinions about your recent experience. Please share any additional
comments about your experiences in having a prescription filled at a military pharmacy. Please
do not share any Personally Identifiable Information (PII)”. [OPEN ENDED]