Thursday, February 19, 2009

Saving money on a prescription could be as easy as having your doctor double its strength, then splitting the pills
By Steve Wartenberg
Reprinted courtesy of The Columbus Dispatch

Cindy Davis was paying $44 a month for Zocor and wasn't happy about the high cost of the cholesterol-reducing tablets. "I started looking around," said the Westerville resident, 45. "It wasn't on the $4 list at Kroger or Giant Eagle, then I found it on the (discount) list at Walmart."

Davis was able to purchase a 90-day supply for a $15 co-pay and, with the approval of her doctor, who doubled the strength of her Zocor prescription, she cut her pills in half so they would last six months.

Her yearly bill for Zocor went from $528 to $30.

"That's a lot of money," Davis said. "I just got back from a week in Florida and it's from that extra money."
Pill-splitting is a growing trend, one recommended by many health insurers, physicians and pharmacists.

But only certain pills such as antidepressants and ones that lower cholesterol and blood pressure are candidates for splitting, which should never be done without a physician's approval.

"This is not a novel concept; it has been around a long time," said Hae Mi Choe, a professor and clinical pharmacist at the University of Michigan Health System.

She conducted a study in 2007 that found splitting cholesterol pills does not reduce their effectiveness.

The study encouraged the university's health-care system to launch a pill-splitting program that saved it $195,000 in the first year and saved more than 500 employees about $25,000 in co-pay costs.

"It was automatic. You didn't have to sign up for it," Choe said.

Health insurers such as UnitedHealthcare and Anthem Blue Cross and Blue Shield offer half-tablet programs. "In Columbus, 12.5 percent of our members are using the half-tab program. Statewide, it is 13.3 percent," said UnitedHealthcare spokeswoman Debora Spano.

UnitedHealthcare provides free tablet-splitters, and they are sold at most pharmacies.
A common antidepressant tablet such as Lexapro is a good candidate for splitting.

"It's scored, which makes splitting easy," said Sarah Hudson-DiSalle, a specialty-practice pharmacist with the Ohio State University Medical Center. "If you don't have insurance, 30 10-milligram tablets cost $85.99 and 15 of the 20-milligram tablets is $52.99 -- a savings of $33 a month."

And $396 a year.

The U.S. Department of Veterans Affairs introduced a pill-splitting program for Zocor in 2003 and saved $46.5 million the first year.
But not every pill can be split.

"Safety comes into play if a medication is time-released or coated to avoid an upset stomach," Hudson-DiSalle said. "And there could be a risk of inaccuracy for a patient who doesn't have the vision or dexterity to split pills."

This, she said, could lead to someone taking 12.5 milligrams of a 20-milligram pill one
day and 7.5 milligrams the next.
"When I was in retail (pharmacy), I often asked people if I could split the pills for them," Hudson-DiSalle said.

To avoid unequal doses for those who cut their own pills, she recommends splitting one pill at a time, not all 30 or 90.

Davis said she cuts two or three at a time "so it evens out over the course of a week."
Richard Gajdowski, an emergency physician and central Ohio market medical director for UnitedHealthcare, splits his blood pressure and cholesterol pills.

"Nobody should leave any money on the table," he said, estimating that he saved $500 last year. "Nobody is satisfied with the cost of medication, and I look at this as an easy way to save money."

Gajdowski said pill-splitting is "cost neutral" for UnitedHealthcare but saves money for employers and employees.

The only losers, he said, are the pharmaceutical companies.

"They don't have a problem with it, but they don't go out of their way to advertise it."
Choe has not met any resistance from doctors.

"The only limitation was physicians not being aware of it," she said, adding that she is not sure why pill-splitting is not more common.

"On our end, it was an easy thing to roll out," Choe said of the program at the University of Michigan Health System. "We've gotten calls from people all over the country. They're interested and want to incorporate it. Will this lead to action? I don't know, but I hope it does."

Davis has become a pill-splitting advocate and convinced her mother to start chopping -- after she got her doctor's approval.

"My advice is to always look around for the lowest price, at the supermarket or pharmacy or even Walmart," she said. "And then cut them in half."

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