Understanding Trust in OTC Medicines: Consumer

and Healthcare Provider Perspectives

Prepared by Nielsen and IMS

Released March 6, 2013
Contents

Objectives
Executive Summary
Research Plan and Survey Design
Key Findings: Consumers
Key Findings: HCPs

Understanding Trust in OTC Medicines March 6, 2013 2

 Objectives

CHPA Wishes to Understand the Drivers of Trust in

OTC Medicines Across Various Constituencies
The Consumer Healthcare Products Association (CHPA) launched the
Your Health at Hand initiative to underscore the value and solutions
OTC medicines provide to American families, to healthcare providers,
and to the U.S. healthcare system overall.

In support of that initiative, CHPA is interested in conducting research to

examine what builds trust in OTC medicines across key audiences:
Consumers
Physicians
Pharmacists

Key Research Objectives:

What drives trust in OTCs among consumers and healthcare professionals?
How do trust drivers in OTCs differ between consumers and professionals?
How do trust drivers differ by key consumer and professional groups?

Understanding Trust in OTC Medicines March 6, 2013 3

 Objectives

Survey Respondent Snapshot

Surveyed adult consumers of all ages regarding 12 types of conditions;

doctor visits ranged from 0-10 times per year.

Consumer respondents included households (HHs) with the following:

demographics:
HHs with kids<4
HHs with kids 4-11
HHs with kids 12-17
Multi-generational HHs
Respondents <65
Respondents aged 65+
Those who care for an adult outside of home

Healthcare professional (HCP) respondents included:

Primary care physicians (PCPs)
Nurse practitioners (NPs)
Pediatricians (Peds)
Pharmacists (Pharms)

Understanding Trust in OTC Medicines March 6, 2013 4

Contents

Objectives
Executive Summary
Research Plan and Survey Design
Key Findings: Consumers
Key Findings: HCPs

Understanding Trust in OTC Medicines March 6, 2013 5

 Executive Summary

Executive Summary
Patient outcomes, efficacy and safety perceptions are the most important
drivers of OTC trust across consumers and various HCP segments.
Consistency is a key theme across all segments.
Efficacy compared to a prescription is a key dynamic between consumer, PCP, and NP.
Four HCP segments have a very high degree of agreement.
Trust drivers vary little across types of OTCs taken (cough & cold; allergy relief; pain medication; upset
stomach OTCs).
Pediatricians as well as consumer households with children <12 also need to know the product is safe to
give to children under 18.

Works consistently Patient outcomes Efficacy Safety

Rank Consumers PCPs NPs Peds Pharms

1 Working Is a treatment that Is a treatment that Is safe to give to Is a treatment that

every time helps me achieve helps me achieve children under 18 helps me achieve
(9%) successful patient successful patient (20%) successful patient
outcomes (17%) outcomes (23%) outcomes (22%)
2 As effective Is something I Is something I Is a treatment that Is something I
as a know will work know will be as helps me achieve know will work
prescription consistently (15%) efficacious as a successful patient consistently (14%)
(8%) prescription (13%) outcomes (19%)
3 Few side Is something I Is something I Is something I Is made with
effects (8%) know will be as know will work know will work ingredients that I
efficacious as a consistently (11%) consistently (11%) know to be safe
prescription (13%) (12%)

Understanding Trust in OTC Research March 6, 2013 6

 Executive Summary

Executive Summary
HCPs feel that OTCs can relieve symptoms before or without a prescription.
PCPs most frequently selected the statement, To relieve symptoms before recommending a prescription
treatment.
For NPs and Peds, the statements were essentially equivalent To relieve symptoms before recommending a
prescription treatment and To relieve symptoms without recommending a prescription treatment.
Pharms felt OTCs are To relieve symptoms without recommending a prescription treatment.
Note that To relieve symptoms while also referring patient is not highly rated.

HCP views of OTCs are important, as many consumers use OTCs without
seeing a healthcare professional.
84% of consumers say they trust their doctors advice on what OTC medicine they should take or give to
others.
Households with kids <12 are less likely than other households to use OTCs without a doctors visit, but most
households with kids <12 are still using OTCs without a doctors visit.

Consumers were more likely to say they have readily used allergy relief
OTCs for symptom relief compared to other OTCs.
Respondents were more likely to occasionally use the remaining OTC segments to alleviate symptoms.
Seasonality may influence these results as the survey was fielded during Hay Fever season.

About 98% of PCPs, NPs, and Pharms and 90% of Peds reported that:
They either have no reservations recommending OTC medication to patients and caregivers or recommend
taking OTC medication and encourage caregivers and patients to read and carefully follow instructions.

Understanding Trust in OTC Medicines March 6, 2013 7

Contents

Objectives
Executive Summary
Research Plan and Survey Design
Key Findings: Consumers
Key Findings: HCPs

Understanding Trust in OTC Medicines March 6, 2013 8

 Research Plan and Survey Design

Survey Design Overall and HCP Respondents

The research plan addresses the surveys objectives regarding trust
drivers in OTC medications.

Nielsen and IMS partnered to conduct surveys among consumers

(Nielsen) and healthcare professionals (IMS) to help understand and
demonstrate what drives consumers and healthcare professionals to
trust OTC medications.

Healthcare Professionals:
Approximately 10 minute online survey among 506
healthcare professionals.

Results were analyzed among key groups:

Primary care physicians (n=125)
Nurse practitioners (n=126)
Pediatricians (n=129)
Pharmacists (n=126)

IMS used its prescription database to identify high

volume healthcare professionals for recruitment.

Understanding Trust in OTC Medicines March 6, 2013 9

 Research Plan and Survey Design

Survey Design Consumer Respondents

1,500 households (HHs) that recorded purchases of OTC products on
Nielsens Homescan Panel in the previous 52 weeks were invited to
participate in a survey about OTC products.
Survey was available 8/20/12 9/10/12.
The primary shopper was asked to complete the survey for all members of the HH.

1,194 respondents completed the survey. 82% of the respondents

confirmed that they purchased OTC products in the past 6 months.

Consumer survey responses were analyzed among

respondents who fall into the following groups:
Pain relief medication given/taken yielding 461 responses
Cold, cough, sinus or flu medications given/taken yielding 158 responses
Allergy relief medications given/taken yielding 183 responses
Upset stomach/acid reflux/antacid medications given/taken yielding 129 responses
Medication taken by respondent yielding 658 responses
Medication given to child/step-child in the home yielding 273 responses
Households with Kids<4 yielding 60 responses
Households with Kids 4-11 yielding 158 responses
Households with Kids 12-17 yielding 130 responses
Multi-Generational HHs yielding 39 responses
Hispanic yielding 65 responses
Non-Hispanic yielding 1,129 responses
Respondents <65 yielding 778 responses
Respondents Aged 65+ yielding 196 responses
Care for Adult Outside of Home yielding 343 responses

Understanding Trust in OTC Medicines March 6, 2013 10

 Research Plan and Survey Design

Assessing Consumer and HCP Trust in OTC Medicines

Both survey designs measure relative importance of potential trust

drivers.

Respondents answered approximately five minutes of profiling

questions, followed by approximately five minutes of an exercise
where they looked at 12 sets of four attributes that were repeated
in different patterns to result in an overall ranking of 20 trust
attributes.

Understanding Trust in OTC Medicines March 6, 2013 11

Contents

Objectives
Executive Summary
Research Plan and Survey Design
Key Findings: Consumers
Key Findings: HCPs

Understanding Trust in OTC Medicines March 6, 2013 12

 Consumers

Efficacy and Safety Perceptions Are the Most Important

Drivers of OTC Trust
Working every time, as effective as a prescription, few side effects, doctor recommended, and safe
ingredients are the most important pillars of consumers trust.

Relative Importance of Attributes Studied (on a scale of 1-10)

Is something I know will work every time 9.1
Is something I know will be as effective as a prescription 8.3
Is something that does not have many side effects 8.3
Is recommended by my doctor 7.7
Is made with ingredients that I know to be safe 7.6
Is backed by clinical research that it is safe to use 6.7
Is a brand I trust 6.5
Is backed by clinical research that it will effectively relieve 6.5
Is recommended by my pharmacist or in-store healthcare 6.4
Is something I would use before seeing a doctor 5.5
Is made by a company I trust 4.8
Is made with ingredients I recognize 4.4
Is available as a store brand 3.5
Has easy to understand instructions 3.3
Is safe to give to children under 18 2.9
Is something I would recommend to friends or family 2.6
Has been endorsed by a person, group, or information source I 2.1
Is recommended by friends or family members 2.1
Is something my mother used to use or give to me 1.2
Is something Ive seen advertised 0.3
Q10. Which of the following is most important and which is least important when you decide which <MEDICATION> that are available over-the-
counter you trust taking (giving to your child/step-child)?

Understanding Trust in OTC Medicines March 6, 2013 13

 Consumers

Trust Pillars Are Similar Across the Four OTC Categories

Safe for children <18 is more important for Cough & Cold and Allergy Relief, but differences are not
significant.

Relative Importance of Attributes Studied (on a scale of 1-10)

9.1

8.8
Is something I know will work every time
9.1

9.3

8.2

8.3
Is something I know will be as effective as a prescription
8.7

8.6

8.4

8.1
Is something that does not have many side effects
8.3
Pain relief medications 8.2

Cough, cold, sinus, or flu 7.5

medications
Allergy relief medications 7.7
Is recommended by my doctor
8.0
Upset stomach/acid
7.6
reflux/antacid medications

Q10. Which of the following is most important and which is least important when you decide which <MEDICATION> that are available over-the-
counter you trust <taking/giving to your child/step-child>?
Understanding Trust in OTC Medicines March 6, 2013 14
 Consumers

Consumer Trust Attribute Insights by Demographic

Category

For HHs with children under 4 years-old, the most important trust attribute in
deciding which OTC medication to take or give to a child is that the medication is
recommended by their doctor.

When choosing a medication for themselves, survey respondents choose a brand

they trust.

Multi-generational HHs, Hispanic HHs, and HHs who care for an adult outside of
their home place a high value on pharmacist or in-store healthcare professional
recommendations.

Multi-generational HHs trust products with easy-to-understand instructions.

HHs with children under 0-17 years-old want to know the product is safe to give to
children under 18 years-old.

Q10. Which of the following is most important and which is least important when you decide which <MEDICATION> that are available over-the-
counter you trust taking (giving to your child/step-child)?

Understanding Trust in OTC Medicines March 6, 2013 15

 Consumers

Consumers Use OTCs to Relieve Symptoms without

Seeing a Healthcare Professional
% respondents by OTC usage

82
To relieve symptoms without seeing a healthcare 84
professional 75
77

21
To relieve symptoms before seeing a healthcare 23
professional 15
11

25
To relieve symptoms following a healthcare 12
professional's advice 26
21

Pain Relief Medication Cough and Cold Allergy Relief Upset Stomach/Acid Reflux/Antacid

Q8. When have you or others in your household used each type of over-the-counter medication? Please select all that apply for each type of
medication.
Sample Size = 969
Understanding Trust in OTC Medicines March 6, 2013 16
 Consumers

OTC Use with a Visit to a Healthcare Professional is

More Likely to Occur in Households with Younger Kids

Households with children under 4 years-old are more likely to

use OTC medicines to relieve symptoms before seeing a
healthcare professional.

However, households with children under four years-old are

more likely to see a healthcare professional for relief from
symptoms of colds, flu, fevers, or coughs (versus other
consumers).

Households with children ages 4-11 years-old are more likely

to use OTC medicines to relieve symptoms before seeing a
healthcare professional and/or following a healthcare
professionals advice.

Q8. When have you or others in your household used over-the-counter medication? Please select all that apply.

Understanding Trust in OTC Medicines March 6, 2013 17

 Consumers

More Consumers Readily Use Allergy/Relief OTCs than

Other OTCs

Q9. Which statement below best describes how you feel about medications that are available over-the-counter?

Sample Size = 931

Understanding Trust in OTC Medicines March 6, 2013 18
 Consumers

Most Consumers Visit HCPs 1-2 Times per Year

Q6. For each household member, please answer the following questions: Frequency of visiting
any type of doctor or healthcare practitioner in the past year

Sample Size = 974

Understanding Trust in OTC Research March 6, 2013 19

 Consumers

Most Consumers Buy Based on Symptoms and Trust

Their Doctors Advice on OTCs

17%
Strongly or
Somewhat
Disagree

Sample Size = 974

Q12. Below are statements that may or may not describe you. We would like to know how much you personally agree or disagree with each statement.

Understanding Trust in OTC Medicines March 6, 2013 20

 Consumers

Older Consumers Are More Likely to Use OTCs Based on

a Healthcare Professionals Recommendation

Respondents who were over 65 years-old were more likely

to use OTCs when recommended by a doctor or
healthcare professional.

Q9. Which statement below best describes how you feel about medications that are available over-the-counter?

Understanding Trust in OTC Medicines March 6, 2013 21

 Consumers

Respondents with Kids Are More Likely to Use the

Internet for Diagnosis

Respondents were most likely to almost always turn to the

Internet to diagnose my/others symptoms:
- When the medication is taken by child
- Households with children under 4 years-old
- Households with children under 12 years-old

Q12. Below are statements that may or may not describe you. We would like to know how much you personally agree or disagree with each statement.

Understanding Trust in OTC Medicines March 6, 2013 22

 Consumers

Higher Education Levels Lead to Better Understanding of

Ingredients and Being Asked for Advice
Top 2 Box Summary - % of respondents who Strongly Agree/Somewhat Agree

I choose which over-the-counter medication to buy based on 91%

90%
the symptoms it treats 90%

I trust my doctor's advice on what over-the-counter 85%

83%
medication I should take or give to others 86%

When it's available, I prefer to use over-the-counter 67%

70%
medications versus a prescription 68%

I know what over-the-counter medications to take or give to 65%

66%
others to feel better faster 64%
61%
I avoid going to the doctor unless I absolutely have to 62%
60%

I understand what the ingredients in different over-the- 52%

64%
counter medicines do 64%

I avoid taking or giving others any type of over-the-counter 26%

23%
medication 25% Female High School or Less (227)

I almost always turn to the Internet to diagnose my/others 19%

27%
symptoms 24%
Female Some College (283)
19%
I avoid taking any type of over-the-counter medication 13%
20%

Others often ask me for advice about what over-the-counter 19% Female College Graduate (388)
26%
medications they should take 29%

Q12. Below are statements that may or may not describe you. We would like to know how much you personally agree or disagree with each statement.
Sample Size = 974
Understanding Trust in OTC Medicines March 6, 2013 23
 Consumers
Family Health Influencers are more likely to use OTCs before seeing a
healthcare professional or based on a healthcare professionals advice

Q8. When have you or others in your household used each type of over-the-counter
medication? Please select all that apply for each type of medication.
% respondents by OTC usage

84%
To relieve symptoms without seeing a healthcare
professional
86%

37%
To relieve symptoms following a healthcare
professional's advice
32%

32%
To relieve symptoms before seeing a healthcare
professional
23%

Family Health Influencers (Strongly/Somewhat Agree - Others often ask for advice on what over-the-counter medicines
they should take)
General Consumers

Understanding Trust in OTC Research March 6, 2013 24

Contents

Objectives
Executive Summary
Research Plan and Survey Design
Key Findings: Consumers
Key Findings: HCPs

Understanding Trust in OTC Medicines March 6, 2013 25

 All HCPs

Successful Patient Outcomes, Consistency and Efficacy

Were the Top 3 Trust Attributes Rated by Most HCPs

Q6. Which of the following attributes (listed above) is most important and which is least important when you decide which OTC Medication you trust
to give to yourself or others in your household?

Understanding Trust in OTC Medicines March 6, 2013 26

 Primary Care Physicians

PCPs Largely Recommend OTC Medications to Relieve

Symptoms Before Recommending a Prescription Treatment

Q4. When have you recommended each type of over-the-counter medication? A. To relieve symptoms instead of recommending a prescription treatment; B.
To relieve symptoms before recommending a prescription treatment; C. To relieve symptoms while also referring patient to another healthcare professionals
advice

Understanding Trust in OTC Medicines March 6, 2013 27

 Nurse Practitioners

NPs Mostly Recommend OTC Medications to Relieve

Symptoms Either Before Recommending or Without
Recommending a Prescription Treatment

Q4. When have you recommended each type of over-the-counter medication? A. To relieve symptoms instead of recommending a prescription treatment; B. To
relieve symptoms before recommending a prescription treatment; C. To relieve symptoms while also referring patient to another healthcare professionals advice

Understanding Trust in OTC Medicines March 6, 2013 28

 Pediatricians

Pediatricians Mostly Recommend OTC Medications to

Relieve Symptoms Either Without Recommending or Before
Recommending a Prescription Treatment

Q4. When have you recommended each type of over-the-counter medication? A. To relieve symptoms instead of recommending a prescription treatment; B. To
relieve symptoms before recommending a prescription treatment; C. To relieve symptoms while also referring patient to another healthcare professionals advice

Understanding Trust in OTC Medicines March 6, 2013 29

 Pharmacists

Pharmacists Recommend OTC Medications to Relieve

Symptoms Either Without Recommending or Before
Recommending a Prescription Treatment

Q4. When have you recommended each type of over-the-counter medication? A. To relieve symptoms instead of recommending a prescription treatment; B.
To relieve symptoms before recommending a prescription treatment; C. To relieve symptoms while also referring patient to another healthcare professionals
advice

Understanding Trust in OTC Medicines March 6, 2013 30

 All HCPs
Most Specialists Either Had No Reservations
Recommending OTC Medications or Would Encourage
Patients to Read and Carefully Follow Instructions Before
Taking the OTC Medication
% respondents describing how they feel about OTC medication that are available over-the-counter

70.0%
64.3
60.0%
60.3

50.0% 52.8

45.0 45.6 44.2

40.0%
38.1 Primary Care Physicians
30.0% 33.3
Nurse Practitioners
20.0%
Pediatricians
10.0% 9.3
2.4 0.8 0.8 1.6
Pharmacists
0.8 0.8
0.0%
I have no I recommend taking I avoid I will only I am reluctant to
reservations OTC Medication recommending OTC recommend OTC recommend OTC
recommending OTC and encourage Medication to Medication to Medication to
Medication to caregivers and patients and caregivers and patients and
patients and patients to read caregivers unless I patients if another caregivers
caregivers and carefully follow feel I have to healthcare
instructions before professional
taking OTC recommends it
Medication

Q5. Which statement (in the table above) best describes how you feel about OTC Medication that are available over-the-counter?

Understanding Trust in OTC Medicines March 6, 2013 31

 All HCPs

Patients and Caregivers Visit Different HCPs for Different

Reasons

Healthcare Professionals Top Reasons Consumers Visit Respondents

Primary Care Physicians Asthma; Cough and Cold

(n=125)

Pediatricians Asthma; Cold; Allergies; Routine Checkup

(n=129)

Pharmacists Cough; Headache/Migraine; Allergies

(n=126)

Nurse Practitioners Anxiety/Depression; Upset Stomach/

(n=126) Heartburn/Digestive Symptoms; Allergies

Q11. What are the reasons that patients and caregivers have come to see you in the past year? Please select all that apply.

Understanding Trust in OTC Medicines March 6, 2013 32