Every year, many individuals with diabetes are switched from their current diabetes medications and/or medical devices to another due to formulary changes in their health insurance plan. This practice is called non-medical switching (NMS), and it is forced upon patients by someone other than the patient's healthcare team. The purpose of this questionnaire is to obtain information about your experiences with NMS in your healthcare practice during 2017. Please click on the appropriate box(es) to indicate your response to each question.

Question Title

* 1. Please tell use who you are.

Question Title

* 2. What type of diabetes do you or your patient have?

Question Title

* 3. Have you experienced non-medical switching of your diabetes medication(s) or medical device(s)?

Question Title

* 4. Which medications were affected? (select all that apply)

Question Title

* 5. Which medical devices were affected? (select all that apply)

Question Title

* 6. Did you have to pay out-of-pocket because your medication/device was no longer on formulary?

Question Title

* 7. Did you have to pay a higher co-pay because your medication/device was moved to a lower tier on formulary?

Question Title

* 8. Did you have to file an appeal with your insurer or ask your healthcare professional to obtain pre-authorization?

Question Title

* 9. Did you experience delays in obtaining your medication/device as a result of non-medical switching?

Question Title

* 10. Did you experience financial hardship as a result of non-medical switching?

Question Title

* 11. Did you or your patient experience any physical harm/consequence (e.g., allergic reaction, increased low or high blood sugar, emergency room visit/hospitalization) as a result of non-medical switching?

Question Title

* 12. Do you believe non-medical switching is in your or your patients' best interests?

Question Title

* 13. Optional Information: Briefly describe the circumstances of your non-medical switching experience and how it impacted you or your patient.

Question Title

* 14. Thank you for completing the questionnaire. If you would like to receive a summary of the results, please provide your contact information below.

T