June 18, 2007 -- Splitting high-dose prescription tablets in half can provide relief from high drug costs without affecting health adversely, a University of Michigan study suggests.
The researchers there looked at the effect of splitting three high-dose cholesterol-lowering pills in half. "Pill splitting did not make any difference in adherence to the medications nor their cholesterol levels," says Hae Mi Choe, PharmD, a clinical assistant professor in the College of Pharmacy at the University of Michigan, Ann Arbor, who is a researcher for the study. The study is published in the June issue of The American Journal of Managed Care.
A pill that is twice the dose isn't typically twice the price, Choe says. The higher-dose pills often cost only a bit more than the lower-dose ones. A patient who needs a 40-milligram pill, for instance, might be able to split an 80-milligram tablet, doubling the supply and saving money.
Her team undertook the research because the cost of drugs can be a barrier for patients. "Drug costs are an important determinant of whether patients take the drugs or not," she says. This is especially true if patients are on multiple medications, she tells WebMD.
Choe's team instructed 111 study participants who were on one of three cholesterol-lowering medications to split the pills in half. The three drugs were Lipitor, Pravachol, and Zocor.
She told half the participants they would get a 50% reduction in their co-payment on each refill and the other half they would not, because she wanted to see if the price difference would affect how well they stuck to their medication schedule and their feelings about dealing with the minor inconvenience of having to split the pill.
The average price reduction in the co-pay for each patient was $5 to $7 a month.
After six months, the researchers compared those who got a price reduction with those who did not, asking about their willingness to continue splitting the pills and also looking at how their cholesterol control had been maintained. At six months, 109 of the 111 completed the survey.
"At the end of the study, we asked, 'Would you continue to pill split if we gave you 50% off [your co-pay]," she says. "And 89% said yes they would."
For most, half off was enough, but 24% said they would only keep halving the pills if the cost of the drugs to them was reduced to nothing.
A Model for the Future?
Both patients and the employers who insure them save money with pill-splitting, Choe says. A year after Choe's research was done, the University of Michigan launched a formal pill-splitting program for employees and retirees. In the first full year, the program saved the University $195,000, Choe says, and saved participants more than $25,000 in drug co-pay costs.
Choe is hopeful more insurers will adopt the co-pay reduction plan once they hear about her study.
"Pill-splitting isn't for every drug or everyone," says Choe, who advises consumers to ask their doctor or pharmacist before splitting any medicines. People with manual dexterity problems, for instance, should probably not try to split pills. Those with cognitive problems may forget to split pills and end up taking too much medicine. Vision problems may make splitting too difficult.
Another expert takes a stronger stand. "From a safety standpoint, not splitting is preferred," says Michael Gaunt, PharmD, a medication safety analyst for the Institute for Safe Medication Practices in Huntingdon Valley, Pa. "But there are situations where it may be necessary," he tells WebMD.
For instance, if the dose the patient needs isn't commercially available, the physician may advise him to split the tablet. Sometimes there are financial reasons, Gaunt says.
Certain medications should not be split, Choe and Gaunt agree. Among them:
- Pills with an enteric coating such as enteric-coated aspirin. When split, Gaunt says, "it will lose the enteric coating and the enteric coating is what helps prevent the tablet from dissolving in the stomach, so it decreases irritation to the stomach."
- Time-release or extended-release medicines should not be split, Gaunt says, because it will affect the extended-release characteristics. With the coating destroyed, you could absorb the medicine too quickly.
"If there is not a good reason to split, don't," Gaunt cautions.
Technique, Buying Tips
If you do split -- with your pharmacist's blessing -- be sure to use a medication splitter designed for the purpose, available at pharmacies and sold over the counter, Gaunt says. No kitchen knives allowed, he says.
Invest in a good splitter, Choe advises. In the study, she gave participants two commercially available splitters. She found that those that were a little more expensive -- the mid range, about $5 -- worked better, as did those with rubber matting at the bottom of the device to hold the pill.