While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
The Problem: Some patients cannot afford the drugs their physicians prescribe for them. Many patients look to physicians for help with lowering their drug costs. Physicians need better information about the cost and insurance coverage of the drugs they prescribe in order to better advise their patients.from 2004 to 2008, Tseng had the opportunity to do that.
Grantee Perspective: Chien-Wen Tseng, MD, MPH, an associate professor of medicine at the John A. Burns School of Medicine at the University of Hawaii, wanted to help physicians consider both cost and effectiveness of drugs when prescribing for their patients. With support from the Robert Wood Johnson Foundation (RWJF) Generalist Physician Faculty Scholars Program from 2004 to 2008, Tseng had the opportunity to do that.
“I wanted to make effective health care more affordable for patients and society as a whole,” said Tseng. “In the program, I found a group of creative, innovative, passionate people who wanted to support me in doing that my way.”
Tseng learned and received support from members of the national advisory committee, program alumni and her classmates. Tseng’s mentor, Larry A. Green, MD, opened doors to people she wanted to work with, and met with her dean and department chair to get their support for Tseng’s work. “Larry is one of the most well-known policy-makers in family medicine. To have his attention and feedback for four years, and to have him believe in me, was empowering,” she said.
The protected research time the program provided was crucial in enabling Tseng to develop a prescribing guide for physicians in Hawaii. She also studied drug coverage variation in Medicare part D (the prescription benefit) formularies and analyzed barriers physicians faced in considering costs when prescribing drugs to Medicare patients under part D.) and in hard copy, the guide summarizes formulary coverage for health plans, retail prices and prior authorization requirements for commonly prescribed classes of drugs. Tseng and her colleagues tested the guide with about 260 physicians.
Results: The Prescribing Guide helps physicians, nurse practitioners and physician assistants in Hawaii identify affordable drugs for their patients. Available online (www.PrescribingGuide.com) and in hard copy, the guide summarizes formulary coverage for health plans, retail prices and prior authorization requirements for commonly prescribed classes of drugs. Tseng and her colleagues tested the guide with about 260 physicians.
Of 190 physicians who participated in the 2008 baseline and follow-up evaluation of the guide, those who said they usually know copayments increased from 11 percent to 29 percent. The percentage who said they check formularies before prescribing drugs nearly doubled, from 34 percent to 67 percent.
“Physicians say it changes their prescribing,” said Tseng, who was promoted to associate professor of medicine during her fellowship.
The guide is currently supported by the University of Hawaii and the nonprofit Pacific Health Research Institute, where Tseng is also a physician investigator.
In the study of physicians’ reports of barriers to considering drug costs when prescribing for patients, Tseng and colleagues surveyed primary care physicians in Hawaii. Nine out of 10 physicians reported that difficulty knowing formulary coverage (94%) and not knowing copayments (91%) were significant barriers to considering drug costs.
Tseng and colleagues also used Medicare data to identify widely covered drugs in common classes (e.g., statins) in Part D formularies in California and Hawaii. In the Journal of the American Medical Association (2007), they reported that formularies varied substantially, and all but one treatment class had at least one widely covered drug at a low co-payment. Under a $100,000 grant from the Agency for Healthcare Research and Quality, Tseng is examining the clinical implications of variation among Medicare formularies nationwide.
Tseng also has collaborated on research projects with many program alumni and continues to tap into the expertise of scholars and national advisory committee members. “It’s a lifetime network,” she said.
RWJF Perspective: The Robert Wood Johnson Foundation established the Generalist Physician Faculty Scholars Program to create a cadre of respected generalist leaders in medical schools who would be in a position to influence curriculum, admissions and scholarship. Junior faculty in family medicine, internal medicine and pediatrics conducted research and built their careers under the guidance of mentors.
“Given the shortage of primary care physicians, we need innovative approaches to encourage medical students to choose careers in generalist fields. The Generalist Physician Faculty Scholars Program was designed to emphasize a scholarly foundation for generalism and improve the quality of the education provided to students who choose this important career path,” said Pamela S. Dickson, MBA, assistant vice president of RWJF’s Health Care Group.
When the program ended in 2008, RWJF created the Robert Wood Johnson Physician Faculty Scholars Program to strengthen the leadership and academic productivity of junior medical school faculty who are dedicated to improving health and health care. It is open not only to generalists, but all physicians.
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