Biosimilar Survey for Employers & Business Coalitions - 2024 Beta Test

Respondent Demographics

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* Name:

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* Title:

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* Company

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* Mailing Address:

Street

City

State

Zip Code

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* Office Telephone Number:

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* E-mail Address:

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* a. What is your organization type? (Check 1)

Employer

Employer Coalition

Employee Benefits Purchasing Group

Union or Trust

Third Party Administrator (TPA)

Other (please specify)

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* b. How is your organization’s health insurance structured? (Check 1)

Self-Insured
(Organization assumes financial risk of providing benefits)

Fully Insured
(Organization buys health insurance from a commercial insurer)

Other (Please specify)

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* c. How many employees/beneficiaries does your organization cover (Check 1)

<500

501 – 1,000

1,001 – 5,000

5,001 – 10,000

10,001 – 20,000

20,001 – 25,000

> 25,001

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* d. What is your industry type? (Check all that apply)

Finance and Insurance

Healthcare and Social Services

Durable Manufacturing

Manufacturing - Other

Public Administration

Education

Retail and Wholesale

Information Technology

Other (please specify)

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* e. Approximately what percentage of your employees’ total health care costs are drugs/medications? (Check 1)

< 5%

6% - 10%

11% - 20%

21% - 25%

>26%

Don’t Know

Other (please specify)