UH professor
tackles drug costs
The issue is critical as
isle prescription prices
doubled in five years
One in three Hawaii patients chooses between getting medicine and paying rent or buying food, according to a recent survey, a University of Hawaii professor said.
About 20 percent of residents have no insurance coverage for prescription drugs, said Dr. Chien-Wen Tseng, professor of family practice.
Tseng is launching a $300,000 study to find ways physicians can help patients get prescriptions filled without having to give up groceries.
She has received a prestigious four-year Robert Wood Johnson grant for a research project addressing those problems. She is one of only 15 physicians across the nation, and the first at UH, selected for the award. It is aimed at strengthening general medical school faculty by supporting research to improve health care.
She said she will work with the Hawaii Medical Service Association and Kaiser Permanente because their prescription drug costs for members have doubled in five years. The state government also spent more than $62 million last year on medicine for 35,000 low-income Medicaid Fee-for-Service patients, she said.
There is a high demand now for generic drugs, and almost every health plan has lower co-payments for generics than brand drugs, Tseng said. But the generic version might not be right for everybody, she said, and there might be only one option for some drugs.
"But for many conditions, there may be two or three good treatments," she said, adding that if doctors knew the prices and which medications would work for patients, it could lower costs.
She said she will start talking to doctors and put together a panel of 10 to 15 experts who deal with prescription drug issues to see if they can come up with general guidelines.
"We want to take certain health conditions, like diabetes, heart problems, high cholesterol and hypertension, and see where people might be able to save money on medications and still get good care," she said.
She has received $10,000 from the Hawaii Clinical Research Center to help create the panel and survey 200 to 300 physicians to get feedback on guidelines. She also has received $25,000 from the HMSA Foundation to develop a curriculum on the issues to train medical residents and faculty.
Tseng has a joint research position with the John A. Burns School of Medicine and Pacific Health Research Institute.
Dr. David Curb, chief executive officer and medical director of the institute, and Dr. Carol Mangione, University of California-Los Angeles professor of medicine, are senior advisors for her research project.
"The problem is the drug market is moving very fast, with new drugs, lots of information, new indications and pricing that varies," Curb said.
Doctors do the best they can, but they do not always have all the information they need to decide the best drug for the best price for a patient, he said.
"And it's getting more complicated as the population ages. More people are on drugs and more people on lower incomes, so there are a lot of decisions individuals have to make about the cost of medications."
With today's technology, Curb said, it might be possible to give a doctor tools, such as a hand-held device linked to the Internet, to provide the latest information on costs and the rationale for using certain drugs.
Tseng pointed out that patients often have no idea how much a prescription will cost until they get to the pharmacy and learn, for example, that 30 pills could cost $120, totaling $1,440 a year.
"In almost no other parts of life do we get something without knowing what it costs us," she said. "You don't walk into a restaurant and eat and get the bill a month later."
But it's not easy to get information about the cost of medicine, Tseng said. "I think everybody's in shock. Physicians don't know the cost, either."
Patients should know their drug benefits, she said, and doctors should know if there are low-cost prescription options and give patients a choice so they can stretch their benefits.
"I'm sure doctors are as frustrated as patients. They really want to help patients," she said. However, it is difficult for them to ask patients if they can afford medications, she said.
The issues are complex because health plan lists of preferred drugs and patient co-payments differ, she said.
She hopes her study will lead to easier ways for doctors to know drug prices and less expensive options that will work for a patient. "Until that happens, we're all going to find drug prices and our insurance premiums increasing."
Dr. Philip Hellreich, a dermatologist and Hawaii Medical Association spokesman, said most of his patients have some type of insurance, but he "could spend all day looking at which drugs are on which formularies (lists)."
His practice is to prescribe the medicine he thinks is best for patients and ask them to call him if they get to the drugstore and find it is not a preferred drug. Then he "goes to plan B."
He said he will work with a patient without insurance and "try to reason what is the cheapest drug I can get away with."
Tseng formerly was a Robert Wood Johnson Clinical Scholar at UCLA, studying what happened to seniors with limited drug benefits.
Her findings, that one in five seniors ran out of drug coverage before the end of the year, were reported by the Journal of the American Medical Association.
She noted Hawaii has "two great programs" for low-income residents who might not qualify for other programs -- Hawaii Prescription Care and the Hawaii RX Plus Program.
"But they have to apply, and physicians have to know about the programs to refer patients," she said.
hawaiimed.hawaii.edu
Pacific Health Research Institute
www.phrihawaii.org
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