Consumer Perceptions of Prescription and Over-the-Counter Drug Advertisements with Promotional Offers

Abstract

Information on the effects of promotional offers in direct-to-consumer (DTC) prescription drug ads is limited. In two studies, we examined the effect of promotional offers (e.g., money-back guarantee) and ad type (creating prescription and OTC drug ads by varying the presence of benefit and risk information). We found little effect of promotional offers. Adding benefit (risk) information to the ad increased consumers’ knowledge of the benefit (risk) information and their efficacy (risk) perceptions. In most cases, adding risk information to an ad with benefit information increased risk knowledge and perceptions without decreasing benefit knowledge or perceptions.

According to data compiled by Nielsen, pharmaceutical companies spent $4.5 billion on direct-to-consumer (DTC) advertising of prescription drugs in the US in 2014 (Dobrow, 2015). At the same time, the out-of-pocket cost of prescription medications has risen for many people (Consumer Reports, 2015), reflected in a 3.4% growth in prescription drug prices between November 2014 and 2015 (Altarum Institute, 2016). DTC advertising for prescription drugs is almost exclusively the purview of on-patent products. This has led some to question whether DTC advertising drives consumers to ask for higher-priced brand name products (e.g., Kravitz et al., 2005), and has even resulted in a call for its elimination (AMA, 2015). Manufacturers tend to place the price of prescription drugs within the context of research and development spending (Pharmaceutical Research and Manufacturers of America, 2015) and point to prescription drug assistance programs and other cost-savings methods as a way to mitigate the cost of products for eligible consumers. Like many product categories (Obeid, 2014), monetary promotions are a common sales technique in the prescription drug area.

The Food and Drug Administration (FDA) has regulatory authority over the labeling of many products (e.g., prescription drugs, over-the-counter drugs, foods) and the advertising of prescription drugs and certain medical devices. The Federal Trade Commission (FTC) regulates the advertising of foods, dietary supplements, and over-the-counter drugs. Because these two agencies operate under different regulations, the advertisements (ads) for these various products are subject to different regulatory requirements. By law, among other requirements, prescription drug ads that make a representation about the product’s safety, effectiveness, or uses (full product ads) must contain a fair balance of information about the product’s benefits and risks (Prescription Drug Advertising Regulations, 2014a). Ads for prescription drugs that do not make representations about the drug (reminder ads) are exempt from the fair balance requirements, although certain representations, such as price, are permitted (Prescription Drug Advertising Regulations, 2014b). Reminder ads are not permitted for prescription products with serious risks presented in a boxed warning in the product’s labeling. Ads for over-the-counter (OTC) drugs, which are regulated differently, typically contain benefit, but not risk, information (Greene, Choudhry, Kesselheim, Brennan, & Shrank, 2012). Because advertising can influence the types of treatments consumers receive (Niederdeppe, Byrne, Avery, & Cantor, 2013), and because some product categories offer both prescription and OTC treatments, it is important to understand how factors that influence informed decision-making vary by ad type.

If a promotional offer in a prescription drug ad acts as a cue in such a way as to result in an unbalanced or misleading impression of a prescription drug’s safety or efficacy, this would raise concerns for the regulation of fair balance (Prescription Drug Advertising Regulations, 2014a). Although promotional offers have been extensively studied in the context of packaged goods, information on their effects in direct-to-consumer (DTC) prescription drug ads is limited. One study by Bhutada, Cook, and Perri (2009) found that a free trial offer in a DTC full product ad for a high cholesterol drug resulted in more favorable perceptions of the drug and the ad (both rated as good/bad, favorable/unfavorable, and pleasant/unpleasant) and greater intentions to ask about the drug. No differences were found in terms of perceived risk. However, the study did not measure perceptions of drug risk and benefit separately or comprehension of risk and benefit information. Additionally, the study was not conducted with the target population (high cholesterol sufferers).

The current study examines what effect, if any, the presence of promotional offers in full product, OTC, and reminder ads has on consumers’ drug perceptions and intentions to pursue treatment. If the promotional offer simply reduces the financial risk of trying the product, we expect to see differences between the promotional offer conditions and the no offer condition on behavioral intention, but not on measures of perceived efficacy. However, if the promotional offer functions as a cue or signal about product quality (Bettman, Luce & Payne, 1998; Rao, 2005), we expect that the perceptions of participants who see a promotional offer will differ from participants who do not see an offer on ratings of perceived efficacy and behavioral intention.

We also examined differences between the types of ads. Because full product ads contain risk information, whereas OTC and reminder ads do not, we expected participants who viewed a full product ad to have greater perceptions of risk and to be better able to report product risks than participants who viewed OTC and reminder ads (Slovic & Peters, 2006). Research has shown that consumers hold more positive attitudes toward OTC advertising, compared to DTC advertising (Lee, King, & Reid, 2015). Because full product and OTC ads contain benefit information, whereas reminder ads do not, we expected that participants who viewed a full product or OTC ad would have greater perceptions of efficacy and be better able to report the benefit of the product than participants who viewed a reminder ad.

We also examined the interaction between promotional offers and the type of ad. Even though Bhutada et al. (2009) found that promotional offers did not affect risk perceptions within full product ads, promotional offers may affect risk perceptions in OTC and reminder ads. It is possible that the presence of risk information in full product ads may mitigate the effect of promotional offers on risk perceptions by providing specific information on which to base an opinion.

Method

Participants

Participants were members of the Ipsos i-Say opt-in internet panel, which consisted of one million households. Adult individuals (18 years of age or older) were invited to participate if they indicated on a screener that they could read English and had been diagnosed with or met the diagnostic criteria for insomnia in Study 1 and high blood pressure in Study 2. There were 2,087 participants in Study 1 and 2,123 in Study 2 (see Table 1 for sample characteristics). These sample sizes were chosen, via a priori power analyses, to provide sufficient power (.90) to detect small effects.

Table 1.

Participant Characteristics: Number (Percentage)

	Study 1: Insomnia	Study 2: High blood pressure
Self-reported medical condition	2087 (100.0%)	2123 (100.0%)
Sex
Male	925 (44.3%)	1126 (53.0%)
Female	1162 (55.7%)	997 (47.0%)
Race/Ethnicity
White, non-Hispanic	1547 (74.1%)	1566 (73.8%)
Black, non-Hispanic	178 (8.5%)	225 (10.6%)
Other, non-Hispanic	109 (5.2%)	123 (5.8%)
Hispanic	252 (12.1%)	205 (9.7%)
No response	1 (0.05%)	4 (0.2%)
Education
Less than high school	51 (2.4%)	122 (5.7%)
High school degree	780 (37.4%)	562 (26.5%)
Some college	570 (27.3%)	512 (24.1%)
Associate’s degree	162 (7.8%)	257 (12.1%)
Bachelor’s degree	353 (16.9%)	432 (20.3%)
Advanced degree	171 (8.2%)	238 (11.2%)
Age
18-40	701 (33.6%)	419 (19.7%)
41-52	754 (36.1%)	487 (22.9%)
53-64	475 (22.8%)	778 (36.6%)
65+	157 (7.5%)	439 (20.7%)
Treating medical condition	1446 (69.3%)	1984 (93.5%)
Prescription drugs covered by insurance	1580 (75.7%)	1794 (84.5%)

Procedure

Both studies followed the same procedure and design. The studies were computer-administered. After passing the screener and reading and agreeing to an informed consent page, participants were told they would be participating in a study about advertising for a new product. In each study, participants were randomly assigned to view one of 15 ads. They were asked to read an ad for a fictional product (“Tralsom” for insomnia [a symptomatic condition] in Study 1 and “Tralcor” for high blood pressure [an asymptomatic condition] in Study 2; see Figure 1 for an example). Participants could spend as long as they liked viewing the ad. Next, participants completed a questionnaire, during which they could refer back to the ad.

Figure 1.

Reminder ad for insomnia condition, Study 1.

Design

There is evidence suggesting type of promotional offer may impact perceptions (Zoellner and Schaefer, 2015). Therefore, we investigated five types of promotional offers ($20 copay reimbursement/$20 off [copay/$ off]; buy one, get one free [BOGO]; 30-day free trial; money-back guarantee; no offer) and three types of ads (full product claim, OTC, and reminder) in a 5 x 3 design. All variations featured the promotional offer in the same location, prominently displayed in the center of the ad. The full product claim ad included both efficacy and risk information about the drug. It was accompanied by a brief summary of product risks on the following page (not shown in Figure 1). To create the OTC ad, we removed the risk information from the full product ad. To create the reminder ad, we removed the efficacy and risk information from the full product ad.

Measures

Perceived benefit.

Participants indicated for how many people out of 100 the drug would work (perceived benefit likelihood). Participants rated how effective the drug would be if it did help a person’s sleep problems (1 = not at all effective, 7 = very effective; perceived benefit magnitude), and how much they agreed that the drug is more effective than other drugs for the same medical condition (1 = strongly disagree, 4 = strongly agree; comparative benefit).

Perceived risk.

Participants indicated how many people out of 100 would have a side effect from the drug (perceived risk likelihood) and how serious side effects would be if the drug did cause side effects (1 = not at all serious, 7 = very serious; perceived risk magnitude). They also rated how much they agreed that the drug is safer than other drugs for the same medical condition (1 = strongly disagree, 4 = strongly agree; comparative safety).

Behavioral intention.

Participants rated two statements—“How likely or not likely are you to try Tralsom [Tralcor]?” and “How likely or not likely are you to look for more information about Tralsom [Tralcor]?”—on how likely they were to perform each behavior (1 = not at all likely, 4 = extremely likely). We created a measure of behavioral intention from the mean of these two items (Cronbach’s α = .91 in Study 1, .89 in Study 2). A separate question assessed participants’ ratings of how likely they were to switch to Tralsom [Tralcor] from their current treatment (1 = not at all likely, 7 = very likely; intention to switch).

Benefit knowledge.

Participants were asked to list the benefits of the drug in their own words. We summed the number of correct benefits listed (0-6 in Study 1; 0-4 in Study 2). In addition, participants saw nine statements about the benefits of the drug (e.g., “Tralsom can help you stay asleep for up to 8 hours”) and were asked to indicate if the statement was true, false, or if they did not know. Correct responses were summed to create a benefit recognition score (0-9 in Study 1; 0-8 in Study 2). Don’t know responses were scored as incorrect.

Risk knowledge.

Participants were asked to list the risks of the drug in their own words. We summed the number of correct risks listed (0-12 in Study 1; 0-7 in Study 2). In addition, participants saw 10 statements about the risks of the drug (e.g., “A common side effect of Tralsom is blurred vision”) and were asked to report if the statement was true, false, or if they did not know. Correct responses were summed to create a risk recognition score (0-10 in Study 1; 0-8 in Study 2). Don’t know responses were scored as incorrect.

Health and demographic characteristics.

Participants reported their age, gender, race, ethnicity, and educational level. They also reported what type of product, if any, they were using to treat their medical condition, their health insurance coverage (yes, no, don’t know), and their prescription drug coverage (yes, no, don’t know). Although not discussed here, for exploratory purposes we asked additional questions including open-ended thoughts about the promotional offer, beliefs about the riskiness and effectiveness of prescription and over-the-counter drugs, favorability toward coupons (Garretson & Burton, 2003; Lichtenstein, Netemeyer, & Burton, 1990;), perceptions of the relationship between price and quality (Lichtenstein, Ridgway, & Netemeyer, 1993), and knowledge of their medical condition.

Analyses

We conducted ANOVAs with main effects and interactions to test the effects of ad type and promotional offer on perceived efficacy, perceived risk, intentions, benefit knowledge, and risk knowledge. When main effects were significant, we examined pairwise comparisons, using Bonferroni-adjusted p-values to account for multiple comparisons (p < .017 [.05/3] for ad type and p < .005 [.05/10] for promotional offer).

Results

Table 2 presents the results for ad type in Studies 1 and 2. Table 3 presents the results for the promotional offer in Studies 1 and 2.

Table 2.

Means (standard errors) in Studies 1 and 2, by ad type.

	Study 1: Insomnia			Study 2: High blood pressure
	Full product	OTC	Reminder	Full product	OTC	Reminder
Perceived drug efficacy likelihood	70.46*^ (26.05)	74.38^ (25.74)	50.97 (34.36)	63.07^ (31.74)	62.76^ (33.74)	44.83 (37.82)
Perceived drug efficacy magnitude	5.66^ (1.15)	5.65^ (1.22)	4.67 (1.41)	5.36^ (1.24)	5.29^ (1.39)	4.36 (1.63)
Comparative benefit	2.86^ (0.69)	2.92^ (0.64)	2.47 (0.81)	2.66^ (0.71)	2.63^ (0.80)	2.25 (0.89)
Perceived drug risk likelihood	23.32*^ (23.39)	18.92^ (25.38)	29.57 (30.53)	22.19^ (23.89)	18.72^ (25.10)	26.68 (32.45)
Perceived drug risk magnitude	4.62*^ (1.62)	3.34^ (1.59)	4.04 (1.42)	5.01*^ (1.57)	3.77^ (1.68)	4.21 (1.56)
Comparative safety	2.79*^ (0.70)	2.97^ (0.82)	2.42 (0.65)	2.50*^ (0.76)	2.70^ (0.78)	2.27 (0.89)
Intention to search/try	1.92*^ (0.88)	2.16^ (0.92)	1.67 (0.80)	1.80*^ (0.88)	1.94^ (0.88)	1.61 (0.84)
Intention to switch	3.65*^ (1.93)	4.09^ (1.84)	3.10 (1.84)	2.94^ (1.89)	3.07^ (1.86)	2.45 (1.78)
Benefit recall	1.12*^ (0.95)	1.41^ (1.09)	0.31 (0.61)	1.13^ (0.92)	1.19^ (0.98)	0.11 (0.32)
Benefit recognition	5.53^ (2.08)	5.40^ (2.08)	1.06 (1.75)	4.60^ (1.76)	4.47^ (1.75)	1.02 (1.61)
Risk recall	1.95*^ (1.56)	0.13 (0.37)	0.12 (0.36)	1.53*^ (1.41)	0.04 (0.26)	0.04 (0.21)
Risk recognition	5.90*^ (2.24)	2.26^ (1.88)	1.07 (1.99)	4.38*^ (1.85)	1.50^ (1.79)	0.85 (1.61)

Note. There were significant interactions between coupon and ad type for perceived drug efficacy likelihood and risk recall in Study 1 and for benefit recall in Study 2. In Study 1, benefit recall = 0-6 correct, benefit recognition = 0-9 correct, risk recall = 0-10 correct, and risk recognition = 0-10 correct. In Study 2, benefit recall = 0-4 correct, benefit recognition = 0-8 correct, risk recall = 0-7 correct, and risk recognition = 0-8 correct. For measures in both studies, perceived benefit likelihood = 0-100 people, perceived benefit magnitude = 1-7 (not at all effective to very effective), comparative benefit = 1-4 (strongly disagree to strongly agree), perceived risk likelihood = 0-100 people, perceived risk magnitude = 1-7 (not at all serious to very serious), comparative safety = 1-4 (strongly disagree to strongly agree), and intention to search/try and intention to switch = 1-4 (not at all likely to 4 extremely likely).

^*Significantly different from the OTC condition, Bonferroni-adjusted p < .017.

^{^}Significantly different from the reminder condition, Bonferroni-adjusted p < .017.

Table 3.

Means (standard errors) in Studies 1 and 2, by promotional offer.

	Study 1: Insomnia					Study 2: High blood pressure
	Copay/ $ off	BOGO	30-day trial	Money-back	No offer	Copay/ $ off	BOGO	30-day trial	Money-back	No offer
Perceived drug efficacy likelihood	65.22 (31.08)	65.32 (31.11)	65.37 (29.00)	61.76* (32.33)	69.54 (29.20)	60.25^ (33.85)	51.33* (36.73)	57.62 (35.39)	55.13 (36.41)	60.03 (34.75)
Perceived drug efficacy magnitude	5.30 (1.34)	5.38 (1.31)	5.39 (1.33)	5.22 (1.32)	5.40 (1.39)	5.04 (1.40)	4.90 (1.55)	5.03 (1.46)	4.90 (1.62)	5.14 (1.47)
Comparative benefit	2.78 (0.72)	2.73 (0.74)	2.75 (0.75)	2.72 (0.76)	2.78 (0.76)	2.53 (0.79)	2.49 (0.82)	2.56 (0.81)	2.45 (0.89)	2.55 (0.80)
Perceived drug risk likelihood	21.67 (24.48)	23.73 (25.86)	23.77 (26.13)	24.68 (27.00)	23.19 (26.26)	20.85 (25.62)	23.43 (28.70)	23.11 (27.53)	24.79 (30.11)	20.34 (25.65)
Perceived drug risk magnitude	3.96 (1.64)	3.98 (1.62)	4.07 (1.66)	3.95 (1.55)	4.03 (1.70)	4.21 (1.64)	4.35 (1.64)	4.32 (1.72)	4.40 (1.73)	4.33 (1.70)
Comparative safety	2.75 (0.74)	2.70 (0.76)	2.72 (0.77)	2.71 (0.78)	2.77 (0.77)	2.48 (0.81)	2.44 (0.83)	2.55 (0.82)	2.46 (0.87)	2.50 (0.81)
Intention to search/try	1.94 (0.89)	1.88 (0.85)	1.96 (0.93)	1.88 (0.88)	1.94 (0.92)	1.77 (0.87)	1.76 (0.89)	1.80 (0.85)	1.81 (0.89)	1.80 (0.88)
Intention to switch	3.75 (1.92)	3.47 (1.89)	3.78 (1.93)	3.64 (1.87)	3.52 (1.95)	2.80 (1.79)	2.81 (1.92)	2.95 (1.86)	2.82 (1.88)	2.73 (1.86)
Benefit recall	0.95 (1.03)	1.03 (1.05)	0.93 (1.01)	0.90 (1.01)	0.97 (1.01)	0.82 (0.97)	0.80 (0.94)	0.85 (0.97)	0.75 (0.90)	0.84 (0.91)
Benefit recognition	4.03 (2.86)	4.03 (2.91)	4.12 (2.84)	3.83 (2.81)	4.17 (2.84)	3.44 (2.45)	3.32 (2.41)	3.42 (2.40)	3.32 (2.35)	3.32 (2.32)
Risk recall	0.76 (1.31)	0.82 (1.33)	0.83 (1.43)	0.64^ (1.17)	0.68 (1.17)	0.48 (1.02)	0.50 (1.07)	0.56 (1.13)	0.55 (1.11)	0.56 (1.08)
Risk recognition	3.08 (2.81)	3.06 (2.97)	3.23 (2.93)	2.98 (2.82)	3.20 (2.95)	2.21 (2.28)	2.07 (2.27)	2.34 (2.30)	2.32 (2.44)	2.15 (2.32)

Note. There were significant interactions between coupon and ad type for perceived drug efficacy likelihood and risk recall in Study 1 and for benefit recall in Study 2. In Study 1, benefit recall = 0-6 correct, benefit recognition = 0-9 correct, risk recall = 0-12 correct, and risk recognition = 0-10 correct. In Study 2, benefit recall = 0-4 correct, benefit recognition = 0-8 correct, risk recall = 0-7 correct, and risk recognition = 0-8 correct. For measures in both studies, perceived benefit likelihood = 0-100 people, perceived benefit magnitude = 1-7 (not at all effective to very effective), comparative benefit = 1-4 (strongly disagree to strongly agree), perceived risk likelihood = 0-100 people, perceived risk magnitude = 1-7 (not at all serious to very serious), comparative safety = 1-4 (strongly disagree to strongly agree), and intention to search/try and intention to switch = 1-4 (not at all likely to 4 extremely likely).

^*Significantly different from the no offer condition, Bonferroni-adjusted p < .005.

^{^}Significantly different from the BOGO (buy one, get one free) condition, Bonferroni-adjusted p < .005.

Perceived benefit

Study 1.

Compared with participants who viewed the reminder ad, participants who viewed the full product and OTC ads thought the drug would work for more people (perceived benefit likelihood: F(1, 2071) = 159.65, p < .001, f = .28 and F(1, 2071) = 229.12, p < .001, f = .33, respectively), that the drug would be more effective (perceived benefit magnitude: F(1, 2072) = 212.61, p < .001, f = .32 and F(1, 2072) = 210.18, p < .001, f = .32), and that the drug would be comparatively more effective (comparative benefit: F(1, 2072) = 100.38, p < .001, f = .22 and F(1, 2072) = 137.99, p < .001, f = .26, respectively). In addition, participants who viewed the OTC ad thought the drug would work for more people than did those who viewed the full product ad (F(1, 2071) = 6.50, p = .01, f = .07).

Participants who viewed the ad with no offer thought the drug would work for more people than did those who viewed the ad with the money-back guarantee promotional offer (F(1, 2071) = 15.61, p < .001, f = .08). There was also a significant interaction between ad type and promotional offer (F(8, 2071) = 2.37, p = .02, f = .09), such that the effect of the promotional offer was only significant when participants viewed the OTC ad.

Study 2.

Compared with participants who viewed the reminder ad, participants who viewed the full product and OTC ads thought the drug would work for more people (perceived benefit likelihood: F(1, 2107) = 97.29, p < .001, f = .21 and F(1, 2107) = 96.53, p < .001, f = .21, respectively), that the drug would be more effective (perceived benefit magnitude: F(1, 2108) = 171.01, p < .001, f = .28 and F(1, 2108) = 152.52, p < .001, f = .27, respectively), and that the drug would be comparatively more effective (comparative benefit: F(1, 2106) = 91.61, p < .001, f = .21 and F(1, 2106) = 81.58, p < .001, f = .20, respectively). Participants who viewed the copay/$ off and no offer ads thought the drug would work for more people than did those who viewed the BOGO ad (perceived benefit likelihood: F(1, 2107) = 13.02, p < .001, f = .08 and F(1, 2107) = 12.84, p < .001, f = .08, respectively).

Perceived risk

Study 1.

Compared with participants who viewed the full product and OTC ads, participants who viewed the reminder ad thought that more people would have side effects (perceived risk likelihood: F(1, 2071) = 13.56, p < .001, f = .08 and F(1, 2071) = 49.65, p < .001, f = .15, respectively) and that the drug was comparatively less safe (comparative safety: F(1, 2071) = 91.51, p < .001, f = .21 and F(1, 2071) = 196.84, p < .001, f = .31, respectively). Participants who viewed the reminder ad thought the drug’s side effects would be more serious than did those who viewed the OTC ad, but less serious than did those who viewed the full product ad (perceived risk magnitude: F(1, 2072) = 70.98, p < .001, f = .18; F(1, 2072) = 49.16, p < .001, f = .15; respectively). In addition, participants who viewed the full product ad thought that more people would have side effects, that the drug was comparatively less safe, and that the drug’s side effects would be more serious than did those who viewed the OTC ad, (perceived risk likelihood: F(1, 2071) = 11.64, p < .001, f = .08; comparative safety: F(1, 2071) = 20.66, p < .001, f = .10; perceived risk magnitude: F(1, 2072) = 243.98, p < .001, f = .34).

Study 2.

Compared with participants who viewed the full product and OTC ads, participants who viewed the reminder ad thought that more people would have side effects (perceived risk likelihood: F(1, 2107) = 90.46, p = .002, f = .06 and F(1, 2107) = 29.65, p < .001, f = .12, respectively) and that the drug was comparatively less safe (comparative safety: F(1, 2106) = 28.45, p < .001, f = .11 and F(1, 2106) = 96.86, p < .001, f = .21, respectively). Participants who viewed the reminder ad thought the drug’s side effects would be more serious than did those who viewed the OTC ad, but less serious than did those who viewed the full product ad (perceived risk magnitude: F(1, 2108) = 25.70, p < .001, f = .11; F(1, 2108) = 87.47, p < .001, f = .20; respectively). In addition, participants who viewed the full product ad thought that the drug was comparatively less safe, and that the drug’s side effects would be more serious than did those who viewed the OTC ad (comparative safety: F(1, 2106) = 19.67, p < .001, f = .10; perceived risk magnitude: F(1, 2108) = 208.87, p < .001, f = .31).

Intentions

Study 1.

Participants who viewed the full product and OTC ads had greater intentions to search/try than did those who viewed the reminder ad (F(1, 2072) = 27.79, p < .001, f = .11 and F(1, 2072) = 111.08, p < .001, f = .23, respectively). In addition, participants who viewed the OTC ad had greater intentions to search/try than did those who viewed the full product ad (F(1, 2072) = 28.59, p < .001, f = .12).

When we excluded participants who reported that they were not treating their insomnia at all (n = 641, 30.7%) from the intention-to-switch analyses, participants who viewed the full product and OTC ads had greater intentions to switch than did those who viewed the reminder ad (F(1, 1431) = 20.86, p < .001, f = .12 and F(1, 1431) = 65.41, p < .001, f = .21, respectively). In addition, participants who viewed the OTC ad had greater intentions to switch than did those who viewed the full product ad (F(1, 1431) = 13.54, p < .001, f = .10).

Study 2.

Participants who viewed the full product and OTC ads had greater intentions to search/try than did those who viewed the reminder ad (F(1, 2107) = 16.54, p < .001, f = .09 and F(1, 2107) = 52.29, p < .001, f = .16, respectively). In addition, participants who viewed the OTC ad had greater intentions to search/try than did those who viewed the full product ad (F(1, 2107) = 9.66, p = .002, f = .07).

When we excluded participants who reported that they were not treating their high blood pressure (n = 139, 6.5%) from the intention-to-switch analyses, participants who viewed the full product and OTC ads had greater intentions to switch than did those who viewed the reminder ad (F(1, 1968) = 22.11, p < .001, f = .10 and F(1, 1968) = 38.02, p < .001, f = .14, respectively).

Benefit knowledge

Study 1.

Compared with participants who viewed the reminder ad, participants who viewed the full product and OTC ads listed more correct benefits (benefit recall: F(1, 2072) = 270.78, p < .001, f = .36 and F(1, 2072) = 500.31, p < .001, f = .49, respectively) and recognized more benefits (benefit recognition: F(1, 2072) = 1763.33, p < .001, f = .92 and F(1, 2072) = 1658.20, p < .001, f = .89, respectively). In addition, participants who viewed the OTC ad listed more correct benefits than did those who viewed the full product ad (F(1, 2072) = 36.29, p < .001, f = .13).

Study 2.

Compared with participants who viewed the reminder ad, participants who viewed the full product and OTC ads listed more correct benefits (benefit recall: F(1, 2108) = 562.35, p < .001, f = .57 and F(1, 2108) = 645.50, p < .001, f = .55, respectively) and recognized more benefits (benefit recognition: F(1, 2108) = 1527.13, p < .001, f = .85 and F(1, 2108) = 1449.94, p < .001, f = .83, respectively). The effect for benefit recall was qualified by a significant interaction between ad type and promotional offer (F(8, 2108) = 2.16, p = .03, f = .09). The pattern suggests that participants who viewed the OTC ad listed more correct benefits than did those who viewed the full product ad when a copay/$ off or BOGO promotional offer was present but that this effect was reversed when a 30-day trial promotional offer was present; however, none of these comparisons reached significance, p > .017.

Risk knowledge

Study 1.

Compared with participants who viewed the reminder and OTC ads, participants who viewed the full product ad listed more correct risks (risk recall: F(1, 2072) = 1271.67, p < .001, f = .78 and F(1, 2072) = 1280.69, p < .001, f = .79, respectively) and recognized more risks (risk recognition: F(1, 2072) = 1931.92, p < .001, f = .97 and F(1, 2072) = 1116.13, p < .001, f = .73, respectively). In addition, participants who viewed the OTC ad recognized more risks than did those who viewed the reminder ad (F(1, 2072) = 118.29, p < .001, f = .24).

Participants who viewed an ad with a BOGO promotional offer listed more correct risks than did those who viewed an ad with a money-back guarantee promotional offer (F(1, 2072) = 8.16, p = .004, f = .06). There was also a significant interaction between ad type and promotional offer (F(8, 2072) = 2.01, p = .04, f = .09), such that the effect of the promotional offer was only significant when participants viewed the full product ad.

Study 2.

Compared with participants who viewed the reminder and OTC ads, participants who viewed the full product ad listed more correct risks (risk recall: F(1, 2108) = 1125.76, p < .001, f = .73 and F(1, 2108) = 1148.75, p < .001, f = .74, respectively) and recognized more risks (risk recognition: F(1, 2108) = 1419.26, p < .001, f = .82 and F(1, 2108) = 958.77, p < .001, f = .67, respectively). In addition, participants who viewed the OTC ad recognized more risks than did those who viewed the reminder ad (F(1, 2108) = 48.43, p < .001, f = .15).

Discussion

In two studies, we examined the role of ad type and promotional offer on consumer perceptions of benefit and risk, as well as retention of information and relevant behavioral intentions. We found large differences in perceptions of drugs depending on whether the ads were full product, OTC, or reminder ads. Adding benefit information to the ad (full product vs. reminder and OTC vs. reminder) increased consumers’ knowledge of the benefit information and their efficacy perceptions. Adding risk information to the ad with benefit information (full product vs. OTC) increased consumers’ knowledge of the risk information and their risk perceptions. In most cases, adding risk information to an ad with benefit information (full product vs. OTC) increased risk knowledge and risk perceptions without decreasing benefit knowledge or benefit perceptions. This is similar to findings showing that risk knowledge and risk perceptions were not affected by the addition of efficacy information in DTC ads (O’Donoghue et al., 2014).

Adding benefit and risk information (full product vs. reminder) increased consumers’ knowledge of the risk information while lowering some risk perceptions. In some cases, knowledge of the risk information was increased just by adding benefit information (OTC vs. reminder risk recognition results). This may have been because participants who saw the OTC ad were able to answer some risk questions correctly based on familiarity with the drug class, something participants in the reminder condition would not have been able to rely on.

Not only did ad type influence perceptions, it also influenced behavioral intentions. Participants who saw an OTC ad or a full product ad reported greater intentions to pursue the treatment than those who saw a reminder ad. A reminder ad is of limited informational value if viewers have not previously been exposed to the product, so it is not surprising that participants who saw the product for the first time in a reminder ad were not motivated to find out more about it. Participants who saw an OTC ad were more likely to pursue the treatment than those who saw a full product ad. It is possible that the difference between OTC and full product ads reflects the fact that consumers can directly purchase an OTC product. Making an appointment with a healthcare professional, keeping that appointment, and filling a prescription is a much bigger investment than stopping at a pharmacy and leaving with a product.

Despite having sufficient statistical power in two studies, we found little effect of promotional offers. The effects we did find were small and did not replicate across studies. This suggests that consumers do not factor promotional offers into their calculus when assessing the benefits and risks of a drug, a finding similar to Bhutada et al. (2009). Although they found differences for perceived benefit, they did not see a difference in perceived risk. We have extended their findings: first, by sampling from populations with the relevant condition; second, by showing that the type of ad does not influence responses to promotional offers. Moreover, we found that the presence or type of promotional offer did not influence behavioral intentions. This is in contrast to previous research showing that cost factors do alter prescription fulfillment behavior for a small percentage of consumers (McHorney & Spain, 2011). It could be that cost is a factor at the purchase point (e.g., after the drug has been prescribed or in the store), rather than at the choice/request point. Thus, neither of our expectations was supported—promotional offers did not affect perceptions or intentions.

Our results were nearly identical in two different medical conditions and two different ad executions. Specifically, insomnia is symptomatic, whereas high blood pressure involves no obvious symptoms. That our findings were so similar in different situations increases confidence in our results. Nonetheless, as in all research, our studies had some limitations. First, participants were recruited from an opt-in online panel, potentially limiting the representativeness of the sample. However, our factorial design and random assignment allowed us to focus on the internal validity of our results. Second, participants viewed the ad under study conditions as opposed to naturally. Although other studies have found that participants tend to spend very little time reading print ads (Aikin, O’Donoghue, Swasy, & Sullivan, 2011), it could be that participants here may have focused more on the ad than they typically would, causing them to mentally process the ad information more thoroughly. If this is so, they may also have processed the promotional offer more thoughtfully, which could have negated its impact as a peripheral cue. Future research should explore this possibility.

The results of this study suggest that the use of coupons or other money-saving features in advertising for OTC or prescription drugs does not alter the risk-benefit calculus of consumers. Participants in two studies with two different medical conditions and ad executions did not differ in their responses to ads regardless of whether there was or was not a promotional offer and what form that promotional offer took. These findings imply that regulations regarding prescription drug advertising offer adequate protections to account for the use of promotional offers in these ads.