Which of the following types of health or medical insurance do you currently have?

• Employer or union provided (your own or through a family member)
• Government issued for low income people (Medicaid)
• Government issued for retiree (Medicare)
• Health insurance marketplace/exchange (ACA, “Obamacare”)
• Military or other Government employee
• Private (self-pay) insurance
• Other
• Do not have insurance

Which of these describes your Medicaid or Medicare plan?

• Managed care - My choice of healthcare providers is limited to those who are in network
• Fee for service - I can choose any healthcare provider who accepts Medicaid or Medicare

How much do you agree or disagree with each of the following statements?

Agree a lot, Agree a little, Neither agree nor disagree, Disagree a little, Disagree a lot

• The high cost of healthcare prevents me from being as healthy as I would like
• I’m willing to pay more for high quality health insurance

In the last 12 months, how have you paid for any prescriptions drugs?

• A prescription assistance program from a drug brand
• A prescription drug plan separate from my health insurance
• A prescription savings program discount card/mobile app (e.g., GoodRx, SingleCare, CVS Reduced Rx, Walgreens Prescription Savings Club)
• Brand-specific coupons, rebates or loyalty cards
• I pay for all prescriptions myself because I have no prescription coverage
• I usually pay for prescriptions myself because my plan has a high deductible
• Medicare Prescription Drug Plan (Part D)
• Prescriptions are included in my health insurance plan
• Other
• No prescription drugs purchased in last 12 months

How many different prescription medications have you had filled for yourself in the last 12 months?

• None
• 1 to 2
• 3 to 5
• 6 to 9
• 10 or more

In the last 12 months, where did you purchase any prescription OR non-prescription drugs?

• Club store (e.g. Costco, Sam’s Club, BJ’s)
• Club store’s website (e.g. costco.com, samsclub.com)
• Drug store chain (e.g. Rite Aid, Walgreens, CVS)
• Drug store chain website (e.g. riteaid.com, walgreens.com, cvs.com)
• Local non-chain drug store
• Mass merchandiser (e.g. Walmart, Target)
• Mass merchandiser’s website (e.g. Walmart.com, target.com)
• Grocery store
• Health/Natural food store
• Amazon.com
• Online pharmacy
• Mail order pharmacy provided by your insurance
• Someplace else
• None purchased in last 12 months