Testimonials Do Not Convert Patients From Brand to Generic Medication

Objectives:

To assess whether the addition of a peer testimonial to an informational mailing increases conversion rates from brand name prescription medications to lower-cost therapeutic equivalents, and whether the testimonial’s efficacy increases when information is added about an affiliation the quoted individual shares with the recipient.

Research Design and Methods:

A total of 5498 union members were randomly assigned to receive 1 of 3 different informational letters: 1 without a testimonial (No Testimonial Group), 1 with a testimonial from a person whose shared union affiliation with the recipient was not disclosed (Unaffiliated Testimonial Group), and 1 with a testimonial from a person whose shared union affiliation with the recipient was disclosed (Affiliated Testimonial Group).

Results:

The conversion rate for the No Testimonial Group was 12.2%, which is higher than the Unaffiliated Testimonial Group rate of 11.3% and the Affiliated Testimonial Group rate of 11.7%. The differences between the groups are not statistically significant.

Conclusions:

Short peer testimonials do not increase the impact of a mailed communication on conversion rates to lower-cost, therapeutically equivalent medications, even when the testimonial is presented as coming from a more socially proximate peer.

Am J Manag Care. 2013;19(9):e314-e31We found that adding a short peer testimonial to a mailed letter about the benefits of generic drugs did not increase the likelihood of the recipient converting to a lower-cost therapeutic alternative.

• Even when the testimonial was from a close peer, there was no increase in conversion rates.

• Testimonials did not decrease the number of days to conversion.

• Organizations do not need to spend the time and effort to solicit short testimonials from peers of their health communication recipients.

Healthcare organizations often try to change individuals’ health behaviors by using printed communications.¹ We hypothesized that adding a peer testimonial to an informational letter would significantly increase the letter’s efficacy, and that the testimonial’s effectiveness would be increasing in the perceived social closeness of the peer to the recipient. Testimonials may work because individuals imitate their peers,^2,3 and studies show that the influence of a peer is increasing in the peer’s social proximity.^4-6

We conducted a randomized controlled trial to assess whether adding a peer testimonial to a mailing increases conversions from brand name prescription medications to lower-cost equivalents. In coordination with a pharmacy benefit manager (PBM), 5498 union members were randomly assigned to receive 1 of 3 informational letters. Members were selected for the study if they had, in the 6 months prior to May 2011, filled a brand name prescription that had a cheaper therapeutic equivalent.

Members in the No Testimonial Group received a letter listing cheaper therapeutic equivalents available for the recipient’s brand name prescription medication and the associated cost savings to the recipient from switching to each of these alternatives. Members in the Unaffiliated Testimonial Group received a letter identical to the No Testimonial letter except for the addition of the following testimonial from a member of their union: “Switching to a lower-cost generic medication puts money back in my pocket every month.” Beneath the testimonial appeared the quoted member’s first name, last initial, city, and state. Members in the Affiliated Testimonial Group received a letter identical to the Unaffiliated Testimonial letter except for the addition of the quoted member’s union affiliation below the testimonial.

The letters were sent on May 1, 2011. The PBM measured the targeted members’ prescription drug claims for 6 months after the mailing.

Table

The conversion rate to lower-cost alternatives for the No Testimonial Group was 12.2%, which is higher than the Unaffiliated Testimonial Group rate of 11.3% and the Affiliated Testimonial Group rate of 11.7%. The differences in the conversion rate between the control and the treatment groups are not statistically significant, and adding demographic controls does not change the significance or the rank order of the groups’ conversion rates (, columns 1-3).

The differences between the control and the treatment groups in the percent of employees who converted to a cheaper alternative and never reconverted to the brand name are also not statistically significant, and including demographic controlsdoes not change their significance (Table 1, columns 4-6).

In conclusion, we found that adding a short peer testimonial to a letter about the benefits of generic drugs did not increase the likelihood of the recipient converting to a lower-cost therapeutic alternative, even when the testimonial was marked as coming from a member of the recipient’s union. These results suggest that organizations need not expend the considerable effort required to solicit short testimonials from peers of their health communication recipients.

Author Affiliations: From National Bureau of Economic Research (JB), Graduate School of Business, Stanford University, Stanford, CA; National Bureau of Economic Research (JJC), Yale School of Management, Yale University, New Haven, CT; National Bureau of Economic Research (DL), Harvard University, Cambridge, MA; National Bureau of Economic Research (BCM), John F. Kennedy School of Government, Harvard University, Cambridge, MA; National Bureau of Economic Research (GR), Cambridge, MA.

Funding Source: We acknowledge individual and collective financial support from National Institutes of Health grants P30-AG-034532, R01-AG-021650, and P01-AG-005842.

Author Disclosures: Drs Beshears, Choi, Laibson, and Madrian and Ms Reynolds report that they have received grants from Humana. Dr Laibson reports that he has also received consultancies from Express Scripts.

Authorship Information: Concept and design (JB, JJC, DL, BCM); acquisition of data (JB, DL, GR); analysis and interpretation of data (JJC, DL, BCM); drafting of the manuscript (JJC, BCM, GR); critical revision of the manuscript for important intellectual content (JJC, BCM, GR); obtaining funding (JB, DL, BCM); administrative, technical, or logistic support (GR); and supervision (JB, JJC, DL, BCM).

Address correspondence to: Gwendolyn Reynolds, MTS, National Bureau of Economic Research, 1050 Massachusetts Ave, ambridge, MA 02138.E-mail: Reynolds@nber.org.1. Sedjo RL, Cox E. The influence of targeted education on medication persistence and generic substitution among consumer-directed health care enrollees. Health Serv Res. 2009;44:2079-2092.

2. Duflo E, Saez E. Participation and investment decisions in a retirement plan: the influence of colleagues’ choices. J Pub Econ. 2002; 85:121-148.

3. Sacerdote B. Peer effects with random assignment: results for Dartmouth roommates. Q J Econ. 2001;116:681-704.

4. Christakis NA, Fowler JH. The spread of obesity in a large social network over 32 years. N Engl J Med. 2007;357:370-379.

5. Hoxby C. Peer effects in the classroom: learning from gender and race variation. NBER Working Paper 7867;2000.

6. Soetevent AR, Kooreman P. A discrete-choice model with social interactions: with an application to high school teen behavior. Journal of Applied Econometrics. 2007;22:599-624.

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