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

J Gen Intern Med. 2019 Mar;34(3):420-428. doi: 10.1007/s11606-018-4791-1. Epub 2019 Jan 10.


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

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

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

Participants: 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).

Conclusions: 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.

Keywords: chronic diseases; medication adherence; pill appearance; survey.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Chronic Disease / drug therapy
  • Chronic Disease / psychology*
  • Cross-Sectional Studies
  • Drugs, Generic / standards*
  • Drugs, Generic / therapeutic use
  • Female
  • Humans
  • Male
  • Medication Adherence / psychology*
  • Middle Aged
  • Patient Preference / psychology*
  • Perception*
  • Surveys and Questionnaires*
  • Young Adult


  • Drugs, Generic