Cutting certain pills in half could slice a hefty amount off of America’s prescription drug costs. While only some types of pills can be split safely, the practice could be used by millions of Americans, including many who take popular cholesterol-lowering drugs, U-M research shows.
A University study adds more evidence that splitting a high-dose pill and swallowing half of it, rather than taking a whole low-dose pill each time, doesn’t change the medicines’ impact on cholesterol levels. It is also the first prospective randomized controlled trial of pill splitting, and the first to look at the impact of out-of-pocket costs on patients’ willingness to take the time to split pills.
The study is published in the June issue of the American Journal of Managed Care by a team from the U-M Health System (UMHS) and the School of Pharmacy.
“This study was done in part to see what the impact would be of having some of the cost savings go back to the patient,” says first author Hae Mi Choe, clinical assistant professor in the college and a UMHS clinical pharmacist.
While the study did not find that out-of-pocket costs had an impact on the participants’ tendency to split and take pills in the six-month study, most participants said reduced copays would be needed to entice them to continue splitting pills.
In its first full year the U-M pill splitting program, launched in 2006, saved the University $195,000 and saved 500 employees and retirees more than $25,000 total in copay costs.
Pill splitting relies on the fact that many medicines are manufactured in tablet formulations that contain different doses of the active ingredient. Some of the higher-dose tablets can be cut in half to produce two lower-dose tablets—for example, 80-milligram tablets can be cut to produce two 40-mg tablets.
Because drug manufacturers and wholesalers don’t usually charge twice the price for the larger dose, the cost of half of a high-dose pill is far lower than the cost of buying a whole pill containing the same dose of medicine. So, pill splitting can save money for the insurance plan or pharmacy-benefit manager that buys the pills for a group of insured patients—and for the employer or government agency that pays for the plan.
Few prescription plans structure their benefits to encourage pill splitting, however. But patients have been splitting pills for years without their doctors’ knowledge to try to save money. Others do it with help from physicians who write prescriptions for a higher dose and instruct patients on how to make one month’s supply last two months. This can result in potentially dangerous confusion, and skew patients’ and doctors’ records.
In recent years, pharmacists have worked to determine which tablets can be safely split, and which cannot. Cholesterol-lowering drugs called statins are among the most widely used classes of medicines, with tens of millions of Americans taking the drugs. They also are good candidates for splitting because they linger in the body for a relatively long time, such that small day-to-day dosage fluctuations that can happen when pills are split don’t make a major difference in cholesterol levels.
In the U-M study involving statins, 200 eligible patients completed the initial survey regarding their perception on pill splitting. Of them, 111 patients agreed to participate in a 6-month trial and half of these were randomized to receive a financial incentive of a 50 percent reduction in copays. On average, the cost reduction was about $5 to $7 per month. In the end, 103 completed the entire study and 109 completed the survey.
The survey showed 89 percent of all participants would be willing to continue splitting pills if they received a copay reduction, and 80 percent said spitting had been “no big deal” for them. Most said it would take a 50-percent copay reduction to entice them to keep splitting, and 24 percent said they would keep splitting only if the out-of-pocket cost was zero.
In addition to Choe, the study’s authors are senior author John Piette, associate professor of internal medicine at the Medical School and member of the Center for Practice Management and Outcomes Research at the VA Ann Arbor Healthcare Center; James Stevenson, director of the UMHS Pharmacy Services Department and associate dean at the College of Pharmacy; Daniel Streetman, former researcher at the College of Pharmacy and UMHS clinical pharmacist; and internal medicine faculty members Dr. Michele Heisler, and Dr. Connie Standiford.
For more information on the program for employees and retirees and their dependents, go to www.umich.edu/~benefits/plans/drugs/special.htm#pillsplit.
