2009 National Pharmacy Study SM

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1 Mass Merchandiser Performance September 2009 Healthcare Practice

2 Table of Contents Topic Page # Overview of Findings... MM-3 Overall Customer Satisfaction...MM-5 Non-Pharmacist Staff MM-8 Store Convenience MM-25 Medication Availability and Information..MM-47 Store Layout and Design..MM-58 Cost Competitiveness MM-63 Remote Ordering Convenience MM-69 Pharmacist..MM-73 MM-2

3 Overview of Findings Mass merchandiser pharmacy performance has remained stable since For the third year, Target ranks highest in the segment, although their overall satisfaction has decreased by 16 index points. The largest decrease in satisfaction is seen with Kmart (33 index point decrease). Drivers of Satisfaction Drivers of satisfaction remain unchanged from 2008 and explain 78% of the customer s overall experience with the pharmacy. Brick and mortar customer experience is driven by seven factors: Non-pharmacist Staff Interaction (24%) Store Convenience (24%) Medication Availability and Information (17%) Layout and Design (13%) Cost Competitiveness (10%) Remote Ordering Convenience (8%) Pharmacist Interactions (4%) Break Point Drivers Key Performance Indicators (KPIs) are individual diagnostic items that have the most significant correlation with the overall pharmacy experience. These represent areas over which the pharmacy has direct control, and go beyond the index scores and satisfaction model in actionability. The KPI break point shows the point at which satisfaction improves significantly and indicates a best practice that pharmacies should consider to improve the overall pharmacy experience. Twelve KPIs have been identified within the brick and mortar pharmacy experience: Wait time before giving Rx/refill information to the pharmacy staff 3 minutes or less Wait time on hold before speaking to a live person Answer calls right away Pharmacy staff member provided medication cost explanation In writing and verbally Pharmacy personnel able to answer any medication cost questions Yes, able to answer Informed by a pharmacy staff member of savings with generic drugs Yes, discussed savings Informed by a pharmacy staff member generic drugs have the same ingredients and equal effectiveness as brand name drugs Yes, discussed effectiveness and ingredients Total wait time for in-person pickup to be ready 7 minutes or less Prescription ready when promised Early or on-time delivery Pharmacy provides health testing or wellness services Yes, services available Given side effects information In writing and verbally Asked by pharmacy staff if wanted to speak to pharmacist Yes, was asked Privacy of area provided for discussion with the pharmacist Yes, completely private 2009 J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-3

4 Non-Pharmacist Staff Ensuring the non-pharmacist staff treat customers courteously and quickly is critical to reaching high satisfaction in this factor. Being able to knowledgeably answer customers questions about prescription costs has a substantial influence on satisfaction. At 801 index points, the average performance for mass merchandisers is roughly comparable to the chain drug store average (798) and below the supermarket average (816). Store Convenience Speed to fill a Rx is a slightly more important attribute than convenient store location in this factor. Mass merchandiser customers are less likely to use drive up pharmacy windows. Only about 6% of mass merchandiser customers have used an in-store clinic and only about 9% of those patients received a prescription during their visit. Medication Availability and Information The Mass Merchandiser average is comparable to satisfaction with supermarkets and chain drug stores in this factor. Store Layout and Design Satisfaction with mass merchandisers (757) is about equal to the chain drug store average (758) but is below the average for supermarkets (792). Mass merchandiser customers are more likely to wait in the store for their prescription. Cost Competitiveness Only 71% of mass merchandiser customers report having drug insurance but their customers report higher satisfaction with their cost competitiveness compared to chains drug stores or supermarkets. Nearly one-half (47%) of mass merchandiser customers participated in a flat-rate generic pricing program. This compares to 13% for chain drug store customers and 26% for supermarket pharmacy customers. Mass merchandiser customers with club models report higher satisfaction around cost. Remote Ordering Convenience Satisfaction with remote ordering is similar for mass merchandisers (864) as for chain drug stores (860), and supermarkets (867). Remote ordering is much more likely for refills than for new prescriptions. Pharmacist Only about 18% of mass merchandiser customers actually speak to a pharmacist, hence the relatively low impact on overall satisfaction. However, if a customer does speak to a pharmacist, the impact is considerably greater. MM-4

5 Overall Customer Satisfaction MM-5

6 Overall Customer Satisfaction Target continues to rank highest in mass merchandiser pharmacy customer satisfaction in 2009, the only pharmacy to rank highest all three years of the study. (Figure MM2) However, Target drops 16 index points from 2008 allowing Costco to gain ground, reducing the gap between the two to 13 points. Kmart s overall score decreased by 33 points from 2008, representing the largest decrease among mass merchandisers. Non-pharmacist Staff and Store Convenience represent the most important factors in the pharmacy customer s experience, each contributing 24% to the total experience. Customer Satisfaction Index Model Brick and Mortar Store Convenience Non-Pharmacist Staff 24% 24% 17% Medication Availability and Information 4% Overall Satisfaction Index 13% Store Layout and Design Pharmacist 8% 10% Cost Competitiveness Remote Ordering Convenience Total N = 8,440 Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-6

7 Overall Customer Satisfaction Index (CSI) Ranking Mass Merchandiser Difference from 2008 Target 831 (16) Costco High Satisfaction Sam's Club 813 (18) Kmart 809 (33) Medium Satisfaction Mass Merchandiser Average 801 (1) Low Satisfaction Walmart Notes: 2, 3 Figure MM2 MM-7

8 Non-Pharmacist Staff MM-8

9 Interactions with Non-pharmacist Staff Target remains the highest ranked pharmacy in 2009 in the Non-pharmacist Staff factor, which contributes significantly to their overall high performance. (Figure MM4) Kmart declines by 35 index points from 2008, the largest decrease in the Non-pharmacist Staff factor among mass merchandisers. Accounting for 24% of the overall pharmacy experience, the Non-pharmacist Staff factor is made up of six attributes with the Courtesy of staff contributing most to the factor (23%) followed closely by the Amount of time spent waiting for someone to assist (21%). The Knowledge of the staff attribute shows the greatest decline in satisfaction from Index Model Composition - Non-Pharmacist Staff Attribute Weights - Non-Pharmacist Staff 24% Store Convenience Satisfaction Ratings Difference from % 23% Courtesy 7.95 (0.03) 17% Medication Availability and Information 21% Time spent waiting for someone to assist me 7.41 (0.06) Overall Satisfaction Index 13% Store Layout and Design 18% Respect for my privacy 7.87 (0.09) 10% Cost Competitiveness 14% 14% Knowledge Concern for my needs 7.59 (0.21) % Pharmacist 8% Remote Prescription Ordering 10% Availability of staff to assist me 7.63 (0.04) Survey Question: Q50a-b,d-g Notes: J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. Figure MM3 MM-9

10 Non-Pharmacist Staff Ranking Difference from 2008 Target 828 (21) Sam's Club 815 (24) High Satisfaction Costco Kmart 808 (35) Medium Satisfaction Mass Merchandiser Average 768 (6) Low Satisfaction Walmart 730 (1) Notes: 2, 3 Figure MM4 MM-10

11 In-Person Order Wait Time Satisfaction is greatest among customers who spend less than four minutes waiting to give their prescriptions to the staff. While little variation is observed between many mass merchandisers, Walmart customers are least likely to give their prescription to the pharmacy staff within 3 minutes (37%). (Figure MM6) Wait Time to Provide Prescription Info to Staff During In-Person Order Overall Satisfaction Index 100% Break Point % 60% 40% 20% % % % 19% % Overall Index 0% Did not have to wait 1-3 minutes 4-10 minutes minutes More than 20 minutes 200 Total N = 1041 Survey Question: P7 How long did you w ait before giving your prescription/refill information to a pharmacy staff? Notes: 8, 10 Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-11

12 Wait Time to Provide Prescription Info to Pharmacy Staff During In-Person Order By Pharmacy Kmart 54% Sam's Club 50% Target 50% Costco 50% Mass Merchandiser Average 44% Walmart 37% 0% 20% 40% 60% 80% 100% % 3 Minutes or Less Total N = 1,041 Survey Question: P7 How long did you w ait before giving your prescription/refill information to a pharmacy staff? Notes: 8 Figure MM6 MM-12

13 Phone Order Wait Time Customers whose calls to the pharmacy are answered right away are significantly more satisfied than those who are put on hold (862 overall index vs. 762). Two thirds (66%) of mass merchandiser pharmacy customers calls are answered right away. Wait on Hold for Local Pharmacy Staff During Phone Order Overall Satisfaction Index 100% % 60% 40% 20% 66% Break % Overall Index 0% 200 Answered right away Put on hold Total N = 380 Survey Question: P9A How long did you wait on hold before speaking to a live person? Notes: 8, 10 Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-13

14 Information Provided Any explanation of the customer s cost is better than not giving one at all, however optimally this explanation would come both verbally and in writing. Written and verbal explanations yield a higher overall index score (853) for customers than those who are only told (842) of their cost, or who receive it only in writing (819). There is a clear opportunity for improvement with this area, as only one in four (24%) receive some kind of explanation, and only one in twenty (5%) received both written and verbal explanations. Differences between mass merchandiser pharmacies are minimal. (Figure MM11) About half of customers report being asked by the non-pharmacist staff if they had questions regarding their prescription, while four percent report they received advice on taking the medication with food or other medications. (Figure MM10) Customers who received advice on taking medication with food or other medications are markedly more satisfied. (Figure MM10) Received Explanation of Rx Cost from Pharmacy Staff Overall Satisfaction Index 100% Breakpoint % 60% 40% 20% 853 6% 5% % 14% 5% 819 8% 76% % Overall Index 0% 200 Both verbal and written Verbally Written No explanation given Total N = 2425 Survey Question: P47 Did a pharmacy staff member provide an explanation of your medication costs including any savings from insurance or Notes: 8 Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-14

15 Received Explanation of Prescription Cost from Pharmacy Staff By Pharmacy Difference from 2008 Costco 6% (2) Sam's Club 5% (3) Mass Merchandiser Average 5% (1) Walmart 4% (1) Target 4% (2) Kmart 4% (2) 0% 20% 40% 60% 80% 100% % Written and Verbal Total N = 2425 Survey Question: P47 Did a pharmacy staff member provide an explanation of your medication costs? Notes: 8 Figure MM10 MM-15

16 Information Provided by Non-Pharmacist Staff Overall Index Ask if any questions about Rx 48% 829 Answer cost-related questions 14% 829 Respond to questions without rush 13% 830 Types of Information Provided Advice on correctly taking Rx Explain side-effects Advice on taking Rx with food or other Rx 5% 4% 10% Discuss other Rx related issues 3% 820 Give other health advice related to Rx 3% 854 The non-pharmacist staff did none of the above 42% 770 0% 20% 40% 60% Total N = 2411 Survey Question: P27a Did a pharmacy staff member w ho is not a pharmacist Notes: 4 Figure MM11 MM-16

17 Information Provided (Continued) Pharmacies whose staff are unable to answer customers cost-related questions pay a significant satisfaction penalty for the lack of knowledge. Only 3% of customers report that pharmacy staff were unable to answer their questions. Yet, a 209 index point gap occurs compared to pharmacies who answer cost questions. Seven in ten customers did not have any cost related questions. The vast majority of mass merchandiser pharmacy customers either had no questions or the pharmacy was able to answer their questions. (Figure MM13) Ability of Pharmacy Staff to Answer Cost-Related Questions Overall Satisfaction Index 100% Breakpoint % 60% 40% 20% % 24% 70% % 619* Overall Index 3% 3% 0% 200 Yes Did not have questions No Total N = 2425 Survey Question: P47a Were the pharmacy personnel able to answ er any questions you had about your medication costs? Notes: 4, 8, 10 Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-17

18 Ability of Pharmacy Staff to Answer Cost-Related Questions By Pharmacy Difference from 2008 Target 96% (1) Kmart 96% 0 Sam's Club 95% 0 Mass Merchandiser Average 95% (1) Walmart 95% 0 Costco 93% (1) 0% 20% 40% 60% 80% 100% % Yes or No Question Total N = 2425 Survey Question: P47A Were the pharmacy personnel able to answ er any questions you had about your medication costs? Notes: 8 Figure MM13 MM-18

19 Information Provided Regarding Generic Drugs Customer satisfaction increases significantly when the customer is told that a generic medication is available. Informing customers of generic alternatives helps to increase satisfaction by 71 index points. Similar to 2008, 37% of customers were told a generic medication was available to them. Informed of Availability of Generic Drug Overall Satisfaction Index 100% % 60% 40% 20% 37% 41% 43% % Overall Index 0% 200 Yes No Total N = 2419 Survey Question: P70 Were you told by a pharmacy staff member that a generic drug w as available to you? Notes: J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. Figure MM14 MM-19

20 Information Provided Regarding Generic Drugs (Continued) Informing customers of the cost benefits of generic alternatives significantly increases satisfaction with the pharmacy. Two in three (68%) customers who were informed a generic medication was available were also told about the cost savings. Notably, mass merchandiser customers are less likely to be covered by prescription drug insurance than customers of other pharmacy channels. (Data not shown) These informed customers on average give their pharmacy an overall satisfaction score of 856, compared to 808 for customers who are not told about the cost savings. Sam s Club has the highest proportion among mass merchandiser pharmacies who are informed about generic cost benefits (80%), compared to only 64% of Target customers. (Figure MM16) Informed of Cost Savings with Generic Drugs Overall Satisfaction Index 100% 80% 60% 40% 20% % Breakpoint % Overall Index 0% 200 Yes No Total N = 921 Survey Question: P71a Were you told how much a generic might save you in cost? Notes: 8, 10 Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-20

21 Informed of Cost Savings with Generic Drugs By Pharmacy Sam's Club 80% Costco 70% Walmart 69% Mass Merchandiser Average 68% Kmart 65% Target 64% 0% 20% 40% 60% 80% 100% Total N = 921 Survey Question: P71A Were you told how much a generic might save you in cost? Notes: 8 % Yes Figure MM16 MM-21

22 Information Provided Regarding Generic Drugs (Continued) Satisfaction can be greatly increased by discussing with customers that generic medications have the same effectiveness and ingredients as brand name medications. A 73 index point difference exists between those who are informed of the comparability of generics and those who were not. Three in four of customers advised of a generic alternative were also told of the effectiveness and ingredients of generic medications. Informed of Equal Effectiveness of Generic and Brand Name Drugs Overall Satisfaction Index 100% 859 Breakpoint % 60% 40% 20% 74% % Overall Index 0% 200 Yes No Total N = 921 Survey Question: P71b Were you told generic drugs had the same ingredients and equal effectiveness as brand name drugs? Notes: 8, 10 Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-22

23 Informed of Equal Effectiveness of Generic and Brand Name Drugs By Pharmacy Sam's Club 79% Kmart 75% Walmart 75% Mass Merchandiser Average 74% Costco 73% Target 66% 0% 20% 40% 60% 80% 100% % Yes Total N = 921 Survey Question: P71B Were you told generic drugs had the same ingredients and equal effectiveness as brand name drugs? Notes: 8 Figure MM18 MM-23

24 Store Convenience MM-24

25 Store Convenience Target achieves the highest rank in Store Convenience among mass merchandisers with an index score of 848, followed closely by Kmart (841). (Figure MM20) Five attributes contribute to the Store Convenience factor, with the two greatest influences being the Speed it took to fill the prescription from ordering to receiving the medication (25%) and Convenience of the store location (24%). Index Model Composition - Store Convenience Attribute Weights - Non-Pharmacist Staff 24% Overall Satisfaction Index 24% Store Convenience 17% 13% Medication Availability and Information Store Layout and Design 25% 24% 18% Speed it took to fill Rx from ordering to receiving the medication Convenience of store location Ease of ordering prescription Satisfaction Ratings Difference from (0.04) % Cost Competitiveness 17% Hours of operation % Pharmacist 8% Remote Ordering Convenience 16% Amount/availability of parking Survey Question: Q49aa-ae 2009 J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. Figure MM19 MM-25

26 Store Convenience Ranking Difference from 2008 Target 848 (11) High Satisfaction Kmart 841 (23) Mass Merchandiser Average Medium Satisfaction Sam's Club 803 (16) Low Satisfaction Costco Walmart Notes: 2, 3 Figure MM20 MM-26

27 Prescription Order Mass Merchandiser customers are equally likely to order prescriptions via phone or in-person (43% and 42%, respectively). Customers who order by phone are more likely to be satisfied than customers who order by other methods. Order methods have changed only slightly from Mass merchandiser customers placing their order in person nearly always go inside the store to order their prescriptions. (Figure MM22) Preferred ordering methods differ for new prescriptions versus refills. In-person orders and doctor contacts are top choices for new prescriptions, while customers prefer automated phone systems for refills. (Figure MM23) Prescription Order Method Overall Satisfaction Index 100% % 60% 40% 20% % 39% % 42% 10% 8% 5% 5% Overall Index 0% Phone In-person Physician ordered Online 200 Total N = 2425 Survey Question: P6 How did you order this most recent prescription? Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-27

28 Prescription Order Method Overall Satisfaction Index 100% 99% 99% % 60% 40% 20% 785 # Overall Index 0% Inside the pharmacy/store 1% 1% At the drive thru window 200 Total N = 1041 Survey Question: P6a How did you place your recent in-person order? Notes: 5 Figure MM22 MM-28

29 Preferred Methods of Ordering Prescription New Refill In person inside a local pharmacy 15% 37% Doctor contacts local pharmacy for me 5% 30% Phone call using an automated system to local pharmacy 8% 38% Methods of Ordering Prescription Online to a local pharmacy Phone call to a person at a local pharmacy In person by drive thru at a local pharmacy 3% 3% 6% 6% 13% 14% Online to a mail-order pharmacy 3% 4% By mail to a mailorder pharmacy 2% 2% By phone to a mailorder pharmacy 2% 4% 0% 20% 40% Total N = 2414 Survey Question: P72 & P72A Which of the following methods would you most prefer to use to order a new/refill prescription? Notes: 9, 10 Figure MM23 MM-29

30 Prescription Delivery Parallel with in-person orders, the vast majority of mass merchandiser pharmacy customers (96%) pick up their prescriptions inside the store. Customers who wait 7 minutes or less for their order to be ready are more satisfied with their pharmacy experience than those who wait longer. (Figure MM25) On average, about half of mass merchandiser customers must wait longer. Walmart customers are more likely to wait beyond the ideal 7-minute time frame. (Figure MM25) Prescription Delivery Method Overall Satisfaction Index 100% 96% 95% % 60% 40% 20% * Overall Index 3% 4% 0% 200 In person inside pharmacy/drug store In person, at drive thru window Total N = 2425 Survey Question: P22 How did you receive your last prescription/refill? Notes: 4 Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-30

31 Wait Time for In-Person Pickup to be Ready Overall Satisfaction Index 100% 80% 60% 40% 20% % 11% Break Point % % % Overall Index 0% Did not have to wait 1-7 minutes 8-15 minutes 16 minutes -1 hour More than 1 hour 200 Total N = 2411 Survey Question: P22b When picking up your prescription, how long did you wait for it to be ready? Notes: 8 Figure MM25 MM-31

32 Wait Time for In-Person Pickup to be Ready By Pharmacy Kmart 56% Sam's Club 51% Costco 48% Target 48% Mass Merchandiser Average 47% Walmart 43% 0% 20% 40% 60% 80% 100% % 7 minutes or Less Total N = 2338 Survey Question: P22B When picking up your prescription, how long did you w ait for it to be ready? Notes: 8 Figure MM26 MM-32

33 Prescription Delivery Time One of the most impactful actions a pharmacy can take is to have the prescription ready at the promised delivery time. Satisfaction among the eight percent of customers whose prescription was delivered past the time the pharmacy told them it would be ready is significantly lower (200 index points) than customers whose prescription was on time. This gap widens to 241 index points compared to customers who receive it early (15% of customers). Walmart customers are the least likely among mass merchandisers to receive their prescription either early or on time (89%). (Figure MM28) Conversely, Walmart s sister brand, Sam s Club, delivers prescriptions early or on time 98% of the time. (Figure MM28) Prescription Delivery Time Overall Satisfaction Index 100% % 60% 40% 20% % 14% 76% % Break Point 8% 611 8% Overall Index 0% Early Exactly on time Past promised time 200 Total N = 2425 Survey Question: P37 Was your prescription ready/delivered to you w hen promised? Notes: 8 Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-33

34 Prescription Delivery Time By Pharmacy Difference from 2008 Sam's Club 98% 2 Kmart 96% 0 Costco 96% 2 Target 96% 1 Mass Merchandiser Average 92% 0 Walmart 89% (1) 0% 20% 40% 60% 80% 100% % Yes (exactly or early) Total N = 2425 Survey Question: P37 Was your prescription ready/delivered to you w hen promised? Notes: 8 Figure MM28 MM-34

35 Prescription Shopping Experience There is a direct and positive relationship between the tenure with a pharmacy and a customer s satisfaction. Customers who fill their prescription for the first time with a pharmacy are less satisfied than customers who have used it for a short period, such as a year or less (742 vs. 773). This patterns continues as tenure increases. Satisfaction is greatest among those customers who have been using the pharmacy for 10 years or more (849). Tenure with Pharmacy Overall Satisfaction Index 100% % 60% 40% 20% % % 20% 19% Overall Index 6% 0% First prescription 1 year or less 2 to 4 years 5 to 9 years 10 years or more Years 200 Total N = 2425 Survey Question: P3 How long have you used your selected pharmacy for prescriptions? Notes: J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. Figure MM29 MM-35

36 Prescription Shopping Experience (Continued) More than one-third of mass merchandiser pharmacy customers (39%) considered using another local or mail-order pharmacy. Among mass merchandiser customers, 44% considered a chain drug store, 19% considered another mass merchandiser, and 13% considered using a mail-order service. (Figure MM31) Regardless of the type of pharmacy customers consider, satisfaction varies little. The most common reasons for choosing a pharmacy are the convenience of the store s location (58%) and the good value for price of medication (57%). (Figure MM32) Considered Other Local or Mail-Order Pharmacies Overall Satisfaction Index 100% % 60% 40% 20% % % Overall Index 0% 200 Yes No Total N = 2408 Survey Question: P84 Before getting your prescription from selected pharmacy, did you consider other local or mail-order pharmacies? Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-36

37 Type of Pharmacy Considered Overall Satisfaction Index 100% 80% 60% 40% 20% 0% * 44% Chain 19% Mass Merchandiser 16% 6% % # 2% Supermarket Independent Mail-Order Hospital/Clinic Overall Index Total N = 759 Survey Question: P84a1 Which other pharmacy did you most seriously consider? Notes: 4, 5, 16 Figure MM31 MM-37

38 Reasons for Choosing Current or Considering Another Pharmacy Current Pharmacy Considered Another Pharmacy Convenient location Good value for price of medications 26% 58% 53% 57% Good customer service Convenient ordering process 16% 21% 35% 33% Types of Reasons They have all my records Convenient pharmacy hours Availability of medications 32% 15% 30% 23% 29% 18% Knowledgeable staff 16% 23% To purchase nonprescription items 13% 21% Reputation of pharmacy 18% 17% Convenient delivery process 9% 9% 0% 20% 40% 60% 80% Total N = 2409 & 987 Survey Question: P86 & P84a2 Why did you choose selected pharmacy for your most recent prescription? What are some of the reasons you considered to purchase your prescription from another pharmacy? Figure MM32 MM-38

39 Prescription Shopping Experience (Continued) Approximately one in ten (12%) mass merchandiser pharmacy customers participate in the store s loyalty program compared to 30% of chain drug store and 60% of supermarket pharmacy customers. A moderate increase in satisfaction of 39 index points is observed among those who participate in the store s loyalty program. Frequent shopping for non-prescription items appears to have a positive correlation with customers overall satisfaction. An incremental drop in satisfaction is observed as shopping frequency decreases. Customers who shop at the mass merchandiser more than once a week are the most satisfied (824) while those who shop at the store once a year are the least satisfied (742). (Figure MM34) Approximately one-third of pharmacy customers (35%) report they shop for non-prescription items at that mass merchandiser at least once a week. (Figure MM34) One in three mass merchandiser customers (32%) also purchased over-the-counter medication while filling their prescription. (Figure MM35) Rewards or Loyalty Program Participation Overall Satisfaction Index 100% % % 60% 40% 20% 12% Overall Index 0% 200 Yes No Total N = 2421 Survey Question: P59G Do you participate in a rew ards or loyalty program from your selected pharmacy? Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-39

40 Shopping Frequency For Non-Prescription Items Overall Satisfaction Index 100% 80% 60% 40% 20% 0% % More than Once a week once a week 23% 23% 21% Twice a month Once a month 13% Once every three months 742* 747* 2% 2% Once a year Less than once a year Overall Index Total N = 2397 Survey Question: P83 How often do you shop for non-prescription items at your selected pharmacy? Notes: 4, 10 Figure MM34 MM-40

41 Purchased Over-the-Counter Medication Overall Satisfaction Index 100% % 60% 40% 20% % 68% Overall Index 0% Yes No 200 Total N = 2396 Survey Question: P88 While filling your most recent prescription, did you purchase any over-the-counter medication? Figure MM35 MM-41

42 Health Testing and Wellness Services Offering health testing services significantly increases satisfaction. Customers of pharmacies who offer health testing services have an average satisfaction score of 832, a 51 point positive gap versus customers whose pharmacies don t offer this service. Yet, about half of mass merchandiser customers (53%) state that they don t know if their pharmacy offers health testing a possible communication opportunity. Twenty-five percent of Kmart customers report the pharmacy offers health testing services, compared to 9% of Target customers reporting these services were available. (Figure MM37) Among the 17% whose pharmacy does offer health testing services, the most common services are high blood pressure testing (50%) and flu shots (31%). (Figure MM38) Similar to 2008, in-store clinic use is relatively low (6%). However, one in five would consider switching to a pharmacy that has one. Approximately one in three say they would consider switching pharmacies for high blood pressure testing (33%), flu shots (32%), or cholesterol testing (30%). (Figure MM38) Health Testing Offering Overall Satisfaction Index 100% 80% 60% 40% 20% % 17% Break Point 29% % 53% % Overall Index 0% Yes No Don't know 200 Total N = 2414 Survey Question: P73 Does the pharmacy you used for your most recent prescription provide health testing or w ellness Notes: 8 Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-42

43 Health Testing Offering By Pharmacy Difference from 2008 Kmart 25% (5) Costco 22% (7) Mass Merchandiser Average 17% 0 Sam's Club 16% (1) Walmart 12% (1) Target 9% (5) 0% 20% 40% 60% 80% 100% % Yes Total N = 2414 Survey Question: P73 Does the pharmacy you used for your most recent prescription provide health testing or w ellness services? Notes: 8 Figure MM37 MM-43

44 Health Services Used and Would Consider Switching Pharmacy to Use Used at Pharmacy Would Consider Switching Pharmacy to Use High blood pressure testing Did not use any health testing or wellness services 33% 37% 44% 50% Flu shots 31% 32% Types of Health Testing and Wellness Services Cholesterol testing Diabetes testing Weight control services Quitting smoking services In-store clinics to treat minor illness Bone density scans 14% 10% 16% 8% 16% 6% 6% 6% 20% 3% 15% 30% Other 2% 1% Asthma/Emphysema testing 1% 7% 0% 20% 40% 60% Total N = 425 & 2412 Survey Question: P74 & P74B Please indicate any of the services that you used in the last year at selected pharmacy. Please indicate the health testing and w ellness services you w ould be w illing to go to another pharmacy to receive if it w as not available at your current pharmacy. Figure MM38 MM-44

45 Health Testing and Wellness Services (Continued) Fewer than one in ten received a prescription from their in-store visit. Received Rx from In-Store Clinic Visit 100% 91% 80% 60% 40% 20% 9% 0% Yes No Total N = 264 Survey Question: P107B Did you receive a prescription as a result of this in-store clinic visit? Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-45

46 Medication Availability and Information MM-46

47 Medication Availability and Information Costco s significant performance increase in the Medication Availability and Information factor (19 point increase) and Target s performance decline (14 point decrease) creates a tie for highest ranked in this factor. (Figure MM41) Accounting for 41% of the Medication Availability and Information factor is the Availability of the prescription medication. Index Model Composition - Medication Availability and Information Attribute Weights - Non-Pharmacist Staff 24% Store Convenience Satisfaction Ratings Difference from % 17% Medication Availability and Information 41% Availability of prescription medication 8.42 (0.05) Overall Satisfaction Index 13% Store Layout and Design 22% Stock and availability of other healthcare items % Cost Competitiveness 19% Usefulness of printed information for Rx 8.16 (0.07) 4% Pharmacist 8% Remote Ordering Convenience 18% Ease of understanding printed Rx information 8.29 (0.07) Survey Question: Q52a-d 2009 J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. Figure MM40 MM-47

48 Medication Availability and Information Ranking Difference from 2008 Target 853 (14) High Satisfaction Costco Kmart 830 (33) Medium Satisfaction Mass Merchandiser Average 829 (4) Sam's Club 828 (18) Walmart Notes: 1, 2, 3 Figure MM41 MM-48

49 Prescription Filling Experience Customers who refill a prescription are slightly more satisfied with their pharmacy experience than those who only have a new prescription. More than twice as many customers obtained prescription refills only versus new prescriptions only on their most recent order. Two in three mass merchandiser customers filled a prescription to treat a chronic medical condition on their most recent visit. Customers who filled their prescription for a chronic medical condition (812) are more satisfied with their pharmacy experience than those obtaining medication for a preventive treatment (789), or a non-chronic medical condition (776). (Figure MM43) Type of Rx Filled Overall Satisfaction Index 100% % 60% 40% 20% % % 23% Overall Index 0% New prescription only Refill only Both new and refill prescription 200 Total N = 2425 Survey Question: P5 What type of prescription did you most recently fill? Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-49

50 Purpose for Recently Filled Rx Overall Satisfaction Index 100% % 60% 40% 20% % * 23% 16% 4% Overall Index 0% Chronic medical condition Non-chronic medical condition Preventative treatment Don't know 200 Total N = 2425 Survey Question: P5A Was the prescription(s) you most recently filled for... Notes: 4 Figure MM43 MM-50

51 Prescription Filling Experience (Continued) Over 4 in 10 (42%) of mass merchandiser pharmacy customers say they have increased their use of generic medications, compared to one in ten (10%) pharmacy customers who have increased their brand name medication use. Change in Generic and Brand Name Drug Use Generic Brand Name 100% 80% 60% 40% 20% 0% 54% 53% 42% 37% 10% 4% Increased Stayed the same Decreased Total N = 3024 Survey Question: P65A & P65B Compared to previous years, has your use of generic/brand name drugs Notes: 14 Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-51

52 Involvement with Obtaining Prescription Overall, 61% of customers report discussing a generic option with their doctor. Forty-two percent asked for a generic and received one, while 5% asked for a generic but the doctor recommended the brand name. This compares with only 29% of both chain drug store and supermarket customers who asked for and received one, perhaps reflecting the lower rates of insurance coverage among mass merchandiser pharmacy customers. Discussion with Physician Regarding Generic Drugs Overall Satisfaction Index 100% 80% 60% 40% 20% * % 11% 5% 4% 39% Overall Index 0% Asked for generic and received prescription Asked for generic but none was available Asked for a generic but doctor recommended brand name Doctor could have prescribed generic but I requested for brand name drug Did not discuss generic options with doctor 200 Total N = 2419 Survey Question: P67 Did you discuss a generic drug option with your doctor? Notes: J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. Figure MM45 MM-52

53 Side Effect Information Satisfaction is greatest when side effect information is given both written and verbally and represents the point at which satisfaction increases significantly. A majority (67%) of customers only get written notice of the potential side effects of their medication. One in four (25%) of mass merchandiser customers report receiving side effect information both in writing and verbally, a slight decline from 30% in About half of customers who received side effect information were given a printed insert or separate brochure. (Figure MM48) Only 14% received side effect information directly from the pharmacist. (Figure MM48) Side Effect Information Provided Overall Satisfaction Index 100% Break Point % 60% 40% 20% 0% % 25% % 63% 771* 722* 2% 2% 4% 4% Overall Index Both written and verbal Written only Verbal only None Total N = 2425 Survey Question: P38 Were you given information, either w ritten or verbal, regarding any side effects of the medication? Notes: 4, 8, J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. Figure MM46 MM-53

54 Side Effect Information Provided By Pharmacy Difference from 2008 Target 28% (7) Kmart 28% (9) Mass Merchandiser Average 25% (5) Sam's Club 24% (10) Costco 23% (10) Walmart 22% (3) 0% 20% 40% 60% 80% 100% % Written and Verbal Total N = 2425 Survey Question: P38 Were you given information, either w ritten or verbal, regarding any side effects of the medication? Notes: 8 Figure MM47 MM-54

55 Method of Receiving Side Effect Information Overall Index A printed insert in the packaging 55% 808 Methods of Receiving Side Effect Information In a separate brochure or instruction sheet provided by the pharmacy Printed on the label Given verbally by the pharmacist Given verbally by nonpharmacist staff 6% 14% 27% 54% Hand written by the pharmacist 1% # 0% 20% 40% 60% 80% Total N = 2296 Survey Question: P39 Was this information Notes: 5, 6 Figure MM48 MM-55

56 Side Effect Information (Continued) Nearly seven in ten (69%) state the verbal side effect information was completely useful to them. Usefulness of Verbal Side Effect Information Overall Satisfaction Index 100% 80% 60% 40% 20% % % # Overall Index 3% 0% Completely useful Somewhat useful Not at all useful 200 Total N = 670 Survey Question: P39A How useful w as the verbal side effect information? Notes: 5, 10 Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-56

57 Store Layout and Design MM-57

58 Store Layout and Design Target scores significantly above the mass merchandiser average on the Store Layout and Design factor, more than 40 index points higher than its closest competitor. (Figure MM51) Store Layout and Design is comprised of four underlying attributes, with Location of prescription counter (28%) and Ease of finding items needed (28%) contributing the most to the factor. Comfort of waiting area is the least satisfying of the four attributes; however, it shows signs of increased performance from Index Model Composition - Store Layout and Design Attribute Weights - Non-Pharmacist Staff 24% Store Convenience Satisfaction Ratings Difference from % 17% Medication Availability and Information 28% Location of prescription counter 7.83 (0.01) Overall Satisfaction Index 13% Store Layout and Design 28% Ease of finding items I need 7.70 (0.10) 10% Cost Competitiveness 24% Cleanliness of store 7.88 (0.02) 4% Pharmacist 8% Remote Ordering Convenience 21% Comfort of waiting area Survey Question: Q49ba-bd Notes: 1, J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. Figure MM50 MM-58

59 Store Layout and Design Ranking Difference from 2008 High Satisfaction Target 795 (12) Mass Merchandiser Average Medium Satisfaction Walmart Costco 748 (11) Low Satisfaction Sam's Club 735 (15) Kmart 728 (49) Notes: 2, 3 Figure MM51 MM-59

60 Store Layout and Design There is little variation in satisfaction when analyzing the location of mass merchandiser pharmacy counter. About half of customers (56%) report the pharmacy counter is at the front of the store. This compares with only 7% of chain drug store and 26% of supermarket pharmacy customers. (Data not shown) Approximately two in three customers wait inside the store for their prescription to be filled. This level is lower than those reported by chain drug store (51%) and supermarket customers (60%). (Figure MM53 and Data not shown) Customers who wait inside the store are slightly more satisfied with their overall pharmacy experience than those who leave and return. (Figure MM53) Pharmacy Counter Location Overall Satisfaction Index 100% % 60% 40% 20% % 31% 12% Overall Index 0% 200 Back of the store Front of the store Middle of the store Total N = 2357 Survey Question: P110 Where was the prescription counter located in the store? Notes: 10 Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-60

61 Waited In Store During Prescription Fill Overall Satisfaction Index 100% % 60% 40% 20% % 35% Overall Index 0% Yes No 200 Total N = 1411 Survey Question: P24 Did you wait in the store for the prescription to be ready? Figure MM53 MM-61

62 Cost Competitiveness MM-62

63 Cost Competitiveness Costco overtakes Sam s Club this year and leads the Cost Competitiveness factor ranking. (Figure MM55) Target and Kmart continue to perform relatively poorly in this factor. Two attributes constitute the Cost Competitiveness factor: Competitiveness of prices for nonprescription healthcare items (57%) and Competiveness of prices for prescriptions (43%). Mass merchandiser pharmacy customers are more satisfied on average with the cost competitiveness of their pharmacy than chain drug store or supermarket pharmacy customers. Index Model Composition - Cost Competitiveness Attribute Weights - Non-Pharmacist Staff 24% Store Convenience Satisfaction Ratings Difference from % 17% Medication Availability and Information 57% Competitiveness prices for nonprescription items 7.97 (0.06) Overall Satisfaction Index 13% Store Layout and Design 10% Cost Competitiveness 43% Competitiveness prices for prescriptions 8.22 (0.05) 8% 4% Pharmacist Remote Ordering Convenience Survey Question: Q53a-b 2009 J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. Figure MM54 MM-63

64 Cost Competitiveness Ranking Difference from 2008 Costco High Satisfaction Sam's Club 847 (14) Walmart Medium Satisfaction Mass Merchandiser Average 808 (5) Target 783 (15) Low Satisfaction Kmart 751 (35) Notes: 2, 3 Figure MM55 MM-64

65 Prescription Insurance Coverage Seven in ten mass merchandiser customers have some form of prescription drug coverage. Satisfaction is roughly comparable for both customer segments. In addition, relatively few customers report using a separate prescription discount card. (Figure MM58) Prescription Insurance Coverage Overall Satisfaction Index 100% % 60% 40% 20% % % Overall Index 0% 200 Yes No Total N = 2425 Survey Question: P29 Do you have health coverage that paid for some or all of the cost for your most recent prescription? Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-65

66 Additional Cost Elements Analysis of flat-rate generic pricing programs, such as $4 generic programs, does not show the satisfaction differentiation it did in With many pharmacies establishing similar programs, there is very little satisfaction difference between customers who participate and those who do not. Nearly one half (47%) of mass merchandiser customers used the flat-rate pricing program in their most recent prescription order. This compares to 26% for supermarkets and only 13% for chain drug store customers. (Data not shown) Additionally, only a small proportion (6%) of customers use a prescription discount card to help pay for their medication. (Figure MM58) Flat-Rate Generic Pricing Program Overall Satisfaction Index 100% % 60% 40% 20% % 38% 15% Overall Index 0% 200 Yes No Don't know Total N = 1995 Survey Question: P107A Was your order part of a pharmacy flat-rate pricing for select generic prescriptions? Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-66

67 Prescription Discount Card Use Overall Satisfaction Index 100% 94% % 60% 40% 20% 822 6% Overall Index 0% Yes No 200 Total N = 2425 Survey Question: P46 Did you use a prescription discount card that was not through your insurance benefit? Figure MM58 MM-67

68 Remote Ordering Convenience MM-68

69 Remote Ordering Convenience Kmart maintains its highest rank among mass merchandisers in the Remote Ordering Convenience factor. (Figure MM60) Although Remote Ordering Convenience contributes eight percent to the overall pharmacy experience on average, for those who order remotely the importance doubles to between 14% and 17%, depending on whether they had a pharmacist experience as well. (See Methodology and Index Model report for further detail.) Index Model Composition - Remote Ordering Convenience Attribute Weights - Non-Pharmacist Staff 24% 24% Store Convenience 17% Medication Availability and Information 23% 21% Length of time required to place the prescription order Ease of placing prescription order Satisfaction Ratings Difference from Overall Satisfaction Index 13% Store Layout and Design 20% Ordering medium (materials, layout and design) % Cost Competitiveness 19% Ease of understanding how to order prescription % Pharmacist 8% Remote Ordering Convenience 18% Usefulness of instructions on how to place order Survey Question: Q54aa-ad Notes: J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. Figure MM59 MM-69

70 Remote Ordering Convenience Ranking Difference from 2008 High Satisfaction Kmart 876 (21) Mass Merchandiser Average Medium Satisfaction Sam's Club 863 (22) Walmart Target 859 (20) Low Satisfaction Costco 854 (6) Notes: 3 Figure MM60 MM-70

71 Phone Order Automated phone systems (APS) are used much more often than speaking directly with a staff member (79% vs. 21%, respectively). There is no substantial difference in satisfaction when customers speak to a pharmacy representative during the ordering process. Phone Order Method Overall Satisfaction Index 100% % 60% 40% 20% 79% % Overall Index 0% 200 Used a local pharmacy automated phone system Spoke with a local pharmacy staff member Total N = 1037 Survey Question: P6B How did you place your recent phone order? Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-71

72 Pharmacist MM-72

73 Pharmacist Kmart ranks highest in Pharmacist interactions (879), followed closely by Sam s Club (876) and Target (873). (Figure MM63) Walmart shows a substantial increase from 2008 (46 point increase), yet is again ranked lowest among mass merchandiser pharmacies in the Pharmacist factor. Similar to Remote Ordering Convenience, the importance of the Pharmacist factor is masked by the small proportion of customers who actually speak with one (17%). Customers who do speak with a pharmacist place a much higher importance on the experience, between 22% and 26%. (See Methodology and Index Model report for further detail.) Index Model Composition - Pharmacist Staff Attribute Weights - Non-Pharmacist Staff 24% Store Convenience Satisfaction Ratings Difference from % 23% Knowledge % Medication Availability and Information 21% Courtesy Overall Satisfaction Index 13% Store Layout and Design 16% Respect for my privacy % Cost Competitiveness 14% 13% Time spent waiting for pharmacist to assist me Concern for my needs 8.14 (0.15) % Pharmacist 8% Remote Ordering Convenience 13% Availability of pharmacist to speak with me 8.52 (0.02) Survey Question: Q51a-b, d-g Notes: J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. Figure MM62 MM-73

74 Pharmacist Staff Ranking Difference from 2008 Kmart 879* (18) High Satisfaction Sam's Club 876* (4) Target 873* 7 Mass Merchandiser Average 846 (22) Medium Satisfaction Costco 836* (8) Low Satisfaction Walmart 827* Notes: 3, 4 Figure MM63 MM-74

75 Interactions with Pharmacist Satisfaction significantly increases if customers are asked if they would like to speak with a pharmacist. Customers who are asked if they want to speak with a pharmacist give an average overall index score that is 62 index points higher than for those who are not asked. In 2009, 43% of customers are asked if they would like to speak to a pharmacist, a slight increase over 38% in Fully 60% of Target customers are asked if they would like to speak with a pharmacist, the highest level for mass merchandiser pharmacies. (Figure MM65) Asked by Staff Member if Wanted to Speak to Pharmacist Overall Satisfaction Index 100% Breakpoint % 60% 40% 20% 43% % 57% % Overall Index 0% 200 Yes No Total N = 2411 Survey Question: P25A When picking up your most recent prescription, did a pharmacy staff ask if you w anted to speak to the pharmacist? Notes: 8 Figure MM J.D. Power and Associates, The McGraw-Hill Companies, Inc. All Rights Reserved. MM-75

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