Journal of General Internal Medicine

, Volume 34, Issue 3, pp 420–428 | Cite as

A Survey of Patients’ Perceptions of Pill Appearance and Responses to Changes in Appearance for Four Chronic Disease Medications

  • Ameet SarpatwariEmail author
  • Joshua J. Gagne
  • Zhigang Lu
  • Eric G. Campbell
  • Wendy J. Carman
  • Cheryl L. Enger
  • Sarah K. Dutcher
  • Wenlei Jiang
  • Aaron S. Kesselheim
Original Research



Generic versions of a drug can vary in appearance, which can impact adherence.


To assess the preferences, perceptions, and responses of patients who experienced a change in the appearance of a generic medication.


Cross-sectional survey of patients from a large commercial health plan.


Adults receiving generic versions of lisinopril, fluoxetine, lamotrigine, or simvastatin who experienced a change in the color or shape of their pills between March 2014 and November 2015.

Main Measures

Likert-scale responses to questions concerning perceptions of generic drug safety and effectiveness, reliance on and preferences for pill appearance, and responses to pill appearance changes. Multivariable logistic regression-modeled predictors of seeking advice and adjusting use following a pill appearance change.

Key Results

Of 814 respondents (response rate = 41%), 72% relied on pill appearance to ensure they took the correct medication. A similar percentage wanted their pills to remain the same color (72%), shape (71%), and size (75%) upon refill, but 58% would not have paid a $1 premium on a $5 co-pay to ensure such consistency. Most respondents (86%) wanted their pharmacists to notify them about pill appearance changes, but only 37% recalled such notification; 21% thought they received the wrong medication, and 8% adjusted medication use. Younger respondents (18–33 vs. 50–57 years) were more likely to seek advice (odds ratio [OR] = 1.91; 95% confidence interval [CI],1.02–3.59), and respondents with lower household income (< $30,000 vs. > $100,000) were more likely to adjust medication use (OR = 3.40; 95% CI,1.09–10.67).


Requiring uniform pill appearance may help increase adherence but presents challenges. Standardized pharmacy notification and education policies may be a more feasible short-term solution.


pill appearance medication adherence chronic diseases survey 



This study was supported by the FDA Office of Generic Drugs and Office of Chief Scientist (HHSF223201310232C).

Compliance with Ethical Standards

The Partners HealthCare Institutional Review Board and the New England Independent Review Board approved this study.

Conflict of Interest

The authors declare that they do not have a conflict of interest.


Views expressed in this publication do not necessarily reflect the official policies of the Department of Health and Human Services, nor does any mention of trade names, commercial practices, or organizations imply endorsement by the US Government.

Supplementary material

11606_2018_4791_MOESM1_ESM.docx (118 kb)
ESM 1 (DOCX 117 kb)


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Ameet Sarpatwari
    • 1
    Email author
  • Joshua J. Gagne
    • 1
  • Zhigang Lu
    • 1
  • Eric G. Campbell
    • 2
  • Wendy J. Carman
    • 3
  • Cheryl L. Enger
    • 3
  • Sarah K. Dutcher
    • 4
  • Wenlei Jiang
    • 4
  • Aaron S. Kesselheim
    • 1
  1. 1.Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Center for Bioethics and HumanitiesUniversity of ColoradoDenverUSA
  3. 3.Epidemiology, OptumAnn ArborUSA
  4. 4.Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and ResearchFood and Drug AdministrationSilver SpringUSA

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