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| What is pill splitting? |
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Pill-splitting can save you money on common prescription drugs, Stanford researchers find
STANFORD, Calif. – Health plans and other health-care organizations are looking for ways to reduce the rising cost of prescription drugs. They suggest using generic drugs, narrowing the choice of drugs that treat specific illnesses and making possible a variety of co-payment options.
In addition, researchers at Stanford University Medical Center have confirmed that a less-common measure - pill-splitting (splitting pills into sections) - could mean lower costs without losing any drug effectiveness or safety. They stress that pill-splitting must begin with a doctor-patient conversation and be performed using careful controls. “When done properly, pill-splitting can be a safe, practical cost-saving strategy,” said Randall Stafford, MD, PhD, a researcher at the Stanford Center for Research in Disease Prevention and lead author of an article published in the August issue of the American Journal of Managed Care. “Physicians should consider using pill-splitting with selected medications and patients. Patients may want to bring it up with their doctors.”
A person may buy many prescription drugs at higher dosages for the same or similar costs as smaller dosages. When instructed by a doctor to split the higher-strength pills into smaller pieces equaling the correct dosage, the patient can cut the cost of those medications up to 50 percent.
Using pharmacy claims information from a commercial managed-care plan in Massachusetts, Stafford and colleagues examined how often pill-splitting was used. They found the practice was not used on a regular basis but even still accounted for an annual savings of $6,200 in the health plan.
Researchers then used an organized screening process to determine which medications were right for pill-splitting. Starting with the 265 medications most commonly prescribed nationally and within the specific health plan, they narrowed the list in stages. First they eliminated drugs that came prepackaged, weren’t available in tablets or were available in only one dosage. They then eliminated medications in which pill-splitting offered savings less than 25 percent based on the average wholesale price. Finally, they eliminated medications in which changing the drug’s physical properties could reduce its performance - such as compounds that chemically would not work if split.
This screening process generated a list of 11 medications commonly used by health plan doctors that researchers agreed could be split safely and effectively. The medications would also cost significantly less (see chart). The average potential savings for each drug over varying dosages, ranged from 23 to 50 percent. A patient taking a 10-mg tablet of lisinopril daily, for example, would have annual medication costs of $340. By prescribing half the number of 20-mg tablets and splitting them, medication costs would drop to $180 annually.
“As a cost-saving approach, pill-splitting has significant potential,” said Stafford, an assistant professor of medicine at the Stanford School of Medicine. He calculated that if pill-splitting became a normal practice among patients, the health plan he studied would save $259,500 annually.
The researchers stress that in order to guarantee patient safety, the pill-splitting must be used only with specific drugs and by specific patients. Just as certain types of medications are unsuitable for pill-splitting including time release medications and those with special coatings, certain patients may be unable to split tablets consistently and accurately. These patients may include those with poor eyesight, loss of limbs, tremors, advanced arthritis, dementia or psychosis. The researchers noted that results are best when the patient used a pill-splitting device.
Pill-splitting should be used only after a discussion between physician and patient, Stafford explained. “We’re not suggesting this as a global solution. It needs to be addressed individually during a doctor-patient meeting.” He noted that the list of 11 medications he identified for pill-splitting isn’t complete and may differ depending on local practices and prices.
The researchers acknowledged that some physicians are reluctant to suggest pill-splitting because of concerns that patients may be unwilling or unable to split pills accurately. Stafford’s research suggests that pill-splitting is likely to be safe and effective with proper screening, but he said further research is needed on this question.
He noted that pill-splitting would help those who pay for prescription drugs out-of-pocket, including the uninsured and some Medicare beneficiaries. For them, pill-splitting “may make newer, more expensive medications available to people who might not otherwise afford them.”
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| Potential Cost Savings |
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| Drug |
Clinical Uses |
% Savings* |
| Clonazepam (Klonopin) |
Panic disorder; epilepsy |
41 |
| Doxazosin (Cardura) |
Hypertension; prostate enlargement |
46 |
| Citalopram (Celexa) |
Depression |
46 |
| Atorvastatin (Lipitor) |
High cholesterol |
33 |
| Paroxetine (Paxil) |
Depression; anxiety |
46 |
| Pravastatin (Pravachol) |
High cholesterol |
23 |
| Nefazodone (Serzone) |
Depression |
49 |
| Sildenafil (Viagra) |
Impotence |
50 |
| Lisinopril (Zestril) |
Congestive heart failure; hypertension |
38 |
| Sertraline (Zoloft) |
Depression |
46 |
| Olanzapine (Zyprexa) |
Schizophrenia; bipolar disorder |
31 |
* average potential cost savings of pill-splitting, in percentage terms, over varying dosages of each medication
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