Divided Opinion on Pill Splitting

Patients looking to save money on their prescriptions are increasingly putting pills under the knife or, to be safe, a pill splitter. They are cutting pills at the suggestion of friends, their doctor or in some cases their insurance company. This latest way to game the pharmaceutical industry leaves many patients and providers asking what the system has come to.

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You may have heard about older or low income patients who cut their blood pressure or cholesterol medications in half because they can’t afford a full dose. This story is about pill splitting with a different twist. A growing number of patients are asking their physicians to double their prescription dose from 20 to 40 milligrams of say Lipitor. Patients then cut each pill in half so that each half is now the prescribed strength. They get double the number of tablets for the same price

ROBERT LEBOW: People have kind of stumbled on the idea. It’s a small way of fighting back and economizing.

Robert Lebow, a primary care doctor in Southbridge, says this method works because the price of many prescriptions is the same whether you’re buying 20 or 40 or 80 milligram tablets.

The real cost of any prescription, according to pharmaceutical manufacturers, is the research and development of each drug…not the production of each pill. Dr. Lebow, who sees a lot of older patients, says he frequently recommends pill splitting to help patients save money.

LEBOW: I’m bending the rules, but I have a lot of people who have to pay for their own medicines, they don’t have a lot of money. And I think it can be done in a way that makes everyone happy.

Well, not everyone. Lori Reilly, Vice President for Policy and Research at Pharmaceutical Researchers and Manufacturers of America or PHRMA, says there are a number of possible pitfalls for patients.

LORI REILLY: Do you remember to split your pill, are you doing it accurately and is it a pill that you can actually split. There may be some pills that just can’t be split. Extended release tablets are a good example of that. These are tablets where, if its split, you may not be getting the right dosage amount in each half of the split. There are some tablets that are coated that makes splitting quite difficult. But people, if they’re told by their insurer or doctor that its OK to split one pill may think it’s OK to split other pills too.

Reilly says the association doesn’t track how much money drug makers are losing from pill splitting. The National Association of Chain Pharmacies discourages the practice. But patients are getting mixed signals. The Veterans Administration says studies show pill splitting, for appropriate patients and appropriate medications, is safe and saves money. The four largest insurers in Massachusetts do not promote pill splitting, but one of the nation’s largest insurers, United Healthcare, does for 18 common medications.

LEWIS SANDY: It’s important for people to recognize that this is a reasonable option to consider.

Lewis Sandy, United’s Senior VP for Clinical Advancement, says consumers can save up to $300 a year.

SANDY: We don’t require anyone to participate in it. The physician is really making the final judgment as to whether or not both the patient and the medication are appropriate for pill splitting in that individual circumstance.

Jean Palmer of Lincoln got United’s “half tablet” brochure in the mail last month. Her husband followed the plan…asking his doctor to double his prescription and then sitting at the kitchen table with the pill cutter United sent him to divide his tablets. But the whole thing just made Jean Palmer mad.

PALMER: Why do people have to cut their pills in half to start deriving a savings. It just seems so absurd, like something out of a Hollywood satire.

JERRY AVORN: This leaflet is quite an artifact of early 21st century medicine in America.

Harvard Medical School professor Jerry Avorn, author of “Powerful Medicines”, reads over United’s half tablet promotion.

AVORN: The sad thing is, yes, this is a way for patients to save money but in all the rest of the industrialized world, the way patients save money on their drugs, the government negotiates with the drug company about what the price shall be. And in the US we made that illegal in 2003, at least in Medicare. So what we have here is the insurance company saying to the patient, we really can’t control the cost of this and the government can’t either so get your doctor to write a double dose and go home and cut your pills in half.

United says it does use its volume purchasing ability to get the lowest possible price for consumers. There is legislation pending in Congress that would establish drug price negotiations for Medicare.

Martha Bebinger