Pill splitting

The subways were delayed today in DC today due to the heat which gave me an opportunity to read this week’s Business Insurance issue. I found an interesting point-counterpoint article on pill splitting. United Healthcare has been one of the most prominent insurers to encourage the practice. It turns out that for example Pfizer charges the same price for a 40 mg pill of the statin Lipitor as it does for a 20 mg pill of the same drug. So if the member on a 20 mg daily dose of the drug gets a 30 day supply of 40 mg pills, she can get two months of the medication for one co-pay.

“According to Tim Heady, chief executive officer of UnitedHealth Pharmaceutical Solutions, [United Healthcare’s] Half Tablet Program offers a potential savings of up to 1 to 2 percent of total drug spend, and members can save up to $300 annually.” Moreover, Stanford University researchers have concluded that the practice has significant potential for cost savings.

The [Stanford] researchers emphasized that pill-splitting must be implemented with drug-specific and patient-specific criteria to ensure patient safety. Just as certain types of medications are unsuitable for pill-splitting – including extended-release medications and those with enteric coatings – certain patients may be unable to split tablets consistently and accurately. Such patients may include those with poor eyesight, loss of a limb, tremors, debilitating arthritis, dementia or psychosis. The researchers noted that results are best when the patient uses a pill-splitting device and is trained to use it. Pill-splitting should be embarked upon only after a discussion between physician and patient, Stafford explained. “We’re not advocating this as a global solution. It needs to be conducted in the context of doctor-patient communication.” He noted that the list of 11 medications he identified for pill-splitting isn’t exhaustive and may differ depending on local practices and prices.

The American Medical Association similarly accepts voluntary pill splitting programs that require doctor input in the pill splitting decision. However, many members do not want to split pills (but if bakeries can slice bread that you purchase from them, why can’t pharmacists split the pills you buy from them ?)

Other insurers, such as Cigna Healthcare, prefer focusing member attention on using low cost generic drugs which are available in all the classes of drugs recommended for splitting, according to Business Insurance. What’s more the brand name manufacturer practice of charging the same price for several dosages is not as prevalent with generic drug manufacturers. Yet other insurers, such as Health Partners, include generic drugs in their pill splitting program.