Robert Wood Johnson Foundation Physician Faculty Scholar grant awarded to UH Med School researcher Dr. Chien-Wen Tseng

Four-year study will help physicians advise patients on drug purchases

University of Hawaiʻi at Mānoa
Dr. Chien-Wen Tseng, (808) 627-3200
Assistant Professor
Jim Manke, (808) 956-6099
Manoa Chancellor's Office
Posted: Jul 15, 2004

Dr. Chien-Wen Tseng, assistant professor of Family Medicine at the University of Hawai‘i (UH) at Manoa has been awarded a $300,000 grant from the Robert Wood Johnson Foundation to study how physicians can help patients afford their prescriptions.

The highly prestigious Generalist Physician Faculty Scholar grant is awarded to only 15 physicians across the nation each year. The program is intended to strengthen generalist physician faculty in the nation‘s medical schools by supporting their research projects to improve health care. Dr. Tseng was nominated by the John A. Burns School of Medicine. It‘s the first time a UH faculty physician has successfully competed for the grant.

Dr. Tseng will use the four-year award to support her study "Designing and Testing Cost-Efficient Prescribing Guidelines for Physicians." Her research comes at an especially critical time when the high cost of prescription drugs and the new Medicare drug benefit are at the forefront of public debate.

A recent survey found that one in three Hawaiʻi residents who use prescription drugs had put off filling their prescriptions or cut back on their food and utilities because of the cost of their medications. In addition, fully 20 percent of Hawaiʻi‘s people have no coverage for prescription drugs.

High prescription drug costs are also affecting Hawaiʻi‘s two major health insurance providers — HMSA and Kaiser. Both insurers report that prescription drug spending for their members has doubled in the last five years. The Hawaiʻi state government has also had to deal with increasing drug costs. The state spent more than $62 million last year on prescription drugs for 35,000 low income patients in the Medicaid Fee-For-Service program alone. In response, the state has begun Prescription Care that aims to match needy patients with discount prescription drug programs. State legislators are also seeking ways to enable Hawaiʻi to negotiate directly with pharmaceutical companies for lower medication prices for low-income residents under the Hawaii Rx program.
Dr. Tseng‘s study focuses on how physicians can help patients think about medication costs when choosing the best treatment. "Most patients who walk out with a new prescription from their doctor have no idea how much it will cost," she says. "And it can be a sticker shock for them to receive a $120 bill for 30 pills, especially when you realize that it adds up to $1,440 each year just for one medication.

"We‘d like patients to ask their doctors about their options," Dr. Tseng adds. "Newer, more expensive drugs may work better for some people, but may not be effective for everyone. Patients want their doctor‘s help in getting the most for their money. Asking their doctor if a less expensive drug will work just as well, especially if a generic drug is available, just makes good sense."

Dr. Tseng points out that physicians are also frustrated. "There‘s nothing worse than knowing your patient is choosing between paying the rent, buying food, or buying his or her cholesterol-lowering medication. Doctors want to help, but they‘re not necessarily trained to talk about cost with patients, and it‘s tough when every patient‘s drug benefit is different.

"What we need are ways to make it easier for doctors to know the cost of drugs, and when less expensive options will work for a particular patient. Until that happens, we‘re all going to find drug prices and our insurance premiums increasing."

Dr. Tseng joined UH as a faculty member in the medical school‘s Department of Family Medicine and Community Health in 2002. Prior to returning to Hawaiʻi, she was a Robert Wood Johnson Clinical Scholar at the University of California, Los Angeles studying what happened to seniors with limited drug benefits. Her findings that as many as 1 in 5 seniors ran out of drug coverage before the end of the year were published in the Journal of the American Medical Association. She holds a joint research position with the Pacific Health Research Institute (PRHI), a non-profit research institution in Hawaiʻi that was founded in 1960s. Her research mentors for the award are Dr. David Curb, Professor of Geriatrics at UH Manoa and CEO of PHRI, and Dr. Carol Mangione, Professor of Medicine at the University of California, Los Angeles.

The Robert Wood Johnson Foundation, based in Princeton, N.J., is the nation's largest philanthropy devoted exclusively to health and health care. The RWJ Foundation awarded more than $300 million in grants in 2003. It concentrates its grant making in four goal areas: to assure that all Americans have access to quality health care at reasonable cost; to improve the quality of care and support for people with chronic health conditions; to promote healthy communities and lifestyles; and to reduce the personal, social and economic harm caused by substance abuse - tobacco, alcohol and illicit drugs.

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