OBJECTIVES: To characterize the variance in appearance and costs of 16 oral solid generic medications in four major chronic disease/drug management classes. METHODS: A commercial drug knowledge database was used to identify frequently prescribed oral solid medications that have at least 3 manufacturer sources (excluding repackagers and relabelers) for calendar year 2014. Four drugs from each of the following chronic therapeutic classes were evaluated; 1) antidiabetics (glyburide 5mg, metformin 500mg, acarbose 50mg, glipizide 10mg); 2) statins (simvastatin 40mg, pravastatin 40mg, atorvastatin 40mg, lovastatin 20mg); 3) beta blockers (metoprolol 100mg, atenolol 50mg, carvedilol 25mg, labetolol 100mg); and 4) heart failure drugs (amlodipine 10mg, losartan 50mg, lisinopril 10mg, valsartan 40mg). These classes were chosen because they are included in CMS MTM quality measures. The physical appearance (color, shape, scoring, and size), identifying imprint, and price (WAC) for each manufacturer’s identical strength product was assessed as to similarity to the other generic versions.  RESULTS: Database review obtained the following number of manufacturers per class: antidiabetics= 43; statins= 39; beta blockers= 38; and heart failure agents= 53. Overall, for all 16 drugs across all 4 disease states, there was an average of 3 different colors, 2 different shapes, 11 manufacturers, and 4 different images. Individually drugs varied from no differences to 8 differences, with color and shape equally contributing to variation (n=8 for >2 colors and >2 shapes). Differences in dosage scoring and size were minor CONCLUSIONS: There are multiple sources of medications for four chronic conditions. With substantial appearance variation among several generically equivalent products, there is strong possibility that a patient may experience a future drug product switch that could increase the likelihood of significant non-adherence, and ultimately result in adverse disease outcomes through discontinuation of prescribed therapy. Pill appearance variation highlights a potential important focus for future chronic disease/medication therapy management.