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'Pill Splitting' Cuts Drug Costs for Patients, Health Plans

Cutting larger-dose tablets in half saves on prescription co-pays, experts say

MONDAY, June 18, 2007 (HealthDay News) -- A practice patients often use to cut down on drug costs, called "pill splitting," can also save money for insurance companies and employers, a study of the University of Michigan's own health benefit plan shows.

In pill splitting, patients cut larger-dose tablets in half to double the amount of smaller-dose pills they receive in a single prescription -- for example, dividing 40-milligram tablets to create twice as many 20-milligram doses for the same price. And since drug companies and pharmacies don't usually double the price of medications as the dose doubles, that can mean lower overall per-pill drug costs and fewer drug store co-pays for consumers.

"Splitting is not really new," added study lead researcher Hae Mi Choe, who is an assistant clinical professor of pharmacy at the university. "What was different about this study was that we found out what it would be like if you return some of those savings to the patient."

Her team's study involved more than 100 university health plan members who take cholesterol-reducing drugs such as statins. Statins tend to be good candidates for splitting, the researchers noted, because they linger in the body for a long time, and any impact splitting might have on their action wouldn't greatly alter their effects.

The authors cautioned, however, that not all pills can be safely split. For example, those that pass through the body rather quickly, or have special time-release coatings, are not good candidates for splitting.

After the six-month randomized trial, 89 percent said they'd be willing to continue splitting their cholesterol medications in exchange for a 50 percent reduction in their prescription co-pays, the study found.

A survey returned by 109 health plan members found that 59 percent would be willing to split medications for as little as $5 to $10 in savings per prescription. However, for 12 percent of the survey respondents, no amount of monetary reward would encourage them to split pills.

In 2006, the university's health benefit plan (which covers 80,000 employees) offered the pill-splitting program for three statin drugs that reduce cholesterol. The program saved 500 employees who chose that option a total of $25,000 in co-pay reductions. In turn, the university saved $195,000 in drug costs, Choe added.

The study, published in the American Journal of Managed Care's June issue, also showed that pill splitting did not negatively affect participants' adherence to either their medication regimens or health status. Other types of medications are expected to be added to the program, Choe said.

In the corporate world, "early adapters" are looking at adding an incentive for pill-splitting in their 2009 health plans, said Eric Michael of Mercer Human Resource Consulting, in Minneapolis, a pharmacist and expert on corporate health plans. The University of Michigan's "study will go a long way toward promoting financial incentives, because it's from a credible, independent source," Michael said.

Splitting co-pays might not be quite enough of a financial incentive to get large numbers of patients to take the extra trouble to split pills, according to Greg Scandlen, president of the nonprofit Consumers for Health Care Choices, based in Maryland. If insurance carriers or employers "shared savings 50-50 with the patient, that would be a real incentive," he added.

And with an increased use of health savings accounts -- from which consumers pay 100 percent of drug costs -- "you'd have a substantial incentive," added Scandlen, whose group supports private health insurance.

Already, some managed care plans require pill splitting without financial incentive for appropriate medications, Michael explained.

Many other prescription drugs already are scored at their surface and are ready to be split apart by hand, Michael added. For example, he noted that Buspar, an anti-anxiety medication, is scored to break in either half or in thirds. Newer medications, he said, are less likely to come pre-scored, he said. According to Choe, participants in the University of Michigan study used pill-splitter devices to avoid problems with pills crumbling or being too hard to cut

Michael said he favors having pharmacists, not patients, split the pills, and some states -- but not all -- already authorize pharmacists to do this for customers. For one thing, certain patient groups, such as the elderly, might not be appropriate for pill splitting because of problems with dexterity, he said.

In addition, "A patient might forget to split and [therefore] might take twice the dose," Michael reasoned. "That might not be life-threatening, depending upon the medication, but it could be if they took it for a sustained amount of time."

Choe agreed that those kinds of concerns should be considered when deciding what pills to include in a splitting program. "If doubling the dose will lead to detrimental consequences, I wouldn't recommend splitting," she said.

More information

There's more on safe medication use at the National Council on Patient Information and Education.

SOURCES: Hae Mi Choe, PharmD, assistant clinical professor, pharmacy, University of Michigan School of Pharmacy; Eric Michael, PharmD, pharmacist and principal, Mercer Human Resource Consulting's office in Minneapolis; Greg Scandlen, president, Consumers for Health Care Choices, Hagerstown, Md.; June 2007, American Journal of Managed Care
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