SAN FRANCISCO (Sept. 3, 2002) -- The practice of cutting high-dose pills in half to save on prescription drug costs won critical backing from a medical research study last week, yet drug makers continue to oppose so-called pill-splitting on medical-safety grounds.
Consumers can safely take half of a higher-dose pill instead of one lower-strength pill for 11 common medications, and they can save up to 50 percent in the process, according to the Stanford University Medical Center study.
The drugs, including Pfizer's Viagra and GlaxoSmithKline's Paxil, are safe for splitting, but only under a doctor's supervision. Many medications will not work if cut in half, and every patient's condition is different, the researchers said.
The study found that one health plan could save up to $260,000 if physicians prescribed split pills for the 11 drugs, because higher-dose pills often cost about the same as their lower-strength counterparts.
Drug-makers say they oppose pill-splitting because it's dangerous, and could lead to ineffective treatment.
"We go through very rigorous tests to determine how our products should be used and that information is very specific, approved by the FDA, and is made available in our package inserts," said Charles Alfaro, spokesman for Roche, manufacturer of Klonopin, which is on the study's list.
But drug makers' opposition to pill-splitting may be rooted in protecting profits as well, industry experts said.
"Their position, as they will tell you, is enunciated with the medical and clinical ramifications in mind, but it's transparent that it's also an economic decision by the industry," said Steven Findlay, director of research at the National Institute for Health Care Management, a non-profit health-care research foundation.
"If this trend were to pick up significant speed it could cut into the revenues and profit margins of the pharmaceutical industry because people would be buying a 30-day supply and getting a 60-day supply," Findlay said.
Pharmaceutical companies could react to an increase in halving pills by changing their price structures.
"If this practice were to truly become widespread throughout the health care system, maybe pharmacy companies would think twice about their current pricing structures for medication," said Dr. Randall Stafford, the lead author of the study and a professor at Stanford's Center for Disease Prevention.
GlaxoSmithKline Mary Anne Rhyne said the company opposed the practice because treatment may be ineffective at half-dose. The idea of changing price structure had "not been looked at," she said.
Pfizer, Inc. and Bristol-Myers Squibb Company did not return calls seeking comment.
The health plan studied by Stanford's researchers already realized annual savings of $6,200 because of current pill-splitting practices. Researchers reviewed pharmacies' prescription claims detailing how many tablets were doled out, and compared that number to how long each prescription was intended to last.
Both health plans and patients can realize cost-savings from halving pills, Stafford said.
"From a patient's viewpoint, if they're paying out-of-pocket there may be a reason to pursue this" with their doctors, Stafford said. "But before a pill-splitting prescription is written, it requires the patient and physician to have a frank discussion of whether this strategy makes sense for a particular medication and the patient's own situation."
The following are the 11 medications found to be safe for splitting, their prescribed uses, and average potential cost savings over varying dosages, according to the study:
| panic disorder; epilepsy | 41 | |
| hypertension, prostate enlargement | 46 | |
| depression | 46 | |
| high cholesterol | 33 | |
| depression; anxiety | 46 | |
| high cholesterol | 23 | |
| depression | 49 | |
| impotence | 50 | |
| congestive heart failure, hypertension | 38 | |
| depression | 46 | |
| schizophrenia, bipolar disorder | 31 |
MILWAUKEE, Wis. (Jun. 11, 2005) - Chopping his Lipitor tablets in half gives Randy Schneider a little thrill.
"I kind of chuckle when I do this," said the 41-year-old line worker at a cheese factory. "It's like I'm making good money per minute if you figure it out."
Schneider saves about $31 for a six-month supply, because double-strength pills don't cost much more than single-strength ones. It takes him 10 minutes to cut the 90 pills in two, and he gets the same supply of cholesterol medicine for less money.
Now, the nation's second-largest health insurer, UnitedHealthcare, is getting behind the practice, giving away pill-splitters and providing advice on which drugs can be safely cut in half.
It is offering half-price on drugs for those who split double-strength pills, cutting the patient's co-payment in half as well.
"It has the potential for meaningful savings," said Tim Heady, CEO of UnitedHealth Pharmaceutical Solutions, a division of UnitedHealthcare, based in Edina, Minn.
"For every patient that chooses to reduce their costs by 50 percent, it would reduce ours and their employer's cost by half of the cost of that prescription as well," he said.
Seniors have split pills to cut costs with the help of their doctors and pharmacists for years. Recently insurers have promoted it as studies have shown it can save on purchasing drugs, a key driver of increased premiums.
The U.S. Department of Veterans Affairs said in November it saved $46.5 million a year by having 1.1 million patients split one cholesterol drug alone, Zocor.
UnitedHealthcare plans to take its program nationwide for 12.5 million drug benefit subscribers before year's end.
Among the 15 pills the insurer recommends splitting are expensive cholesterol drugs such as Lipitor, antidepressants such as Zoloft, and blood pressure pills such as Aceon and Diovan. Those pills can be split without adverse effects, Heady said.
But Pfizer Inc., the maker of Lipitor and Zoloft, disputes that. Splitting a pill and leaving it in a steamy bathroom, for example, could change the nature of the drug, said the company's Dr. Mark Horn. It amounts to an "unlabeled use of our medicines" that has not been rigorously tested, Horn said.
The federal Food and Drug Administration does not regulate pill-splitting, but says there are risks such as forgetting to split pills, or unevenly breaking ones for which a precise daily dosage is needed.
It is crucial to have the consent of a doctor, said Tom McGinnis, FDA's director of pharmacy affairs. Doctors can judge whether a patient is capable of splitting pills, or whether they are likely to forgo taking their medicine if they feel it's too expensive. The doctor would need to write a prescription for double the required strength.
UnitedHealthcare is advising customers to split certain pills in half to cut costs in a program that is expected to be offered nationwide by year's end. It recommends these drugs can be cut in half safely, with a doctor's consent:
