Cutting edge

By Michaela Gibson Morris/NEMS Daily Journal

With money tighter than ever, more people need their health care dollars go further.
People who take certain kinds of medication may be able to reduce their prescription costs by pill-splitting. The first step is to talk with your physician and pharmacist.
“For some it may be valuable,” said North Mississippi Medical Center pharmacist Ronnie Crosswhite. “When you do start pill-splitting, you have to realize you are taking on an extra level of responsibility.”
In a recent UnitedHealth Care, more than half of Americans said they would consider splitting their pills to save money if their doctor gave the OK. However, only about 9 percent of people take medications that can be safely split.
“Because prescription costs are continuing to increase …, we’re all looking for ways to save money,” said Dr. Penny Walker, senior medical director for UnitedHealth in the Southeast.
Here’s how it works: If appropriate, your physician prescribes your medication at double strength. Using a pill splitter at home, you half the medicine to get the right dose. Do not split medicine unless specifically directed to by a physician.
Because double-strength medicines aren’t double the price, you, your insurance company and your employer – if they provide your insurance – save money by turning a 30-day supply of medicine into a 60-day supply of medicine.
Here’s the catch: Not every medication can be split and not everyone is up for the extra work.
“It’s only for certain medication and only on certain patients,” Crosswhite said.
Some drugs can be easily split, such as cholesterol-lowering statins or anti-depressants, Crosswhite said.
The broad criteria for medications that can be split into smaller doses are:
- Can be easily split without crumbling.
- Do not have a special coating.
- Medication that is taken only once a day.
- The medicine should have a broad therapeutic range. Even if the split isn’t perfect, the medicine will keep working, without becoming toxic.
Time-release or long-acting medicines can’t be split effectively, Crosswhite said.
“It’s like cutting a liquid gel,” Crosswhite said. “It all comes out at once. You’ll get too much at one time.”
Ideally, a physician’s orders for pill-splitting should be spelled out in their prescription, so that any healthcare provider who reads the label or the electronic record understands the intended dose, Crosswhite said. Otherwise, there could be confusion and a person could end up with a double dose of their medicine.
UnitedHealth Care’s program requires that, but rules can vary from insurer to insurer.

Positive experience
UnitedHealth started its voluntary Half Tablet program in 2006. About 10 percent of its members participate.
“It’s been very popular,” Walker said.
It averages out to savings of about 80 cents per member per month. And it benefits the person, the insurance company and the employer if they offer insurance.
“That doesn’t sound like much, but it really does add up,” Walker said.
For a group with 1,000 members, that would add up to $9,600 in a year.
“The lower the copay, the more compliant patients are,” Walker said.

Good equipment
It’s important to invest in a pill-splitting device, which is far more accurate than freehanded splits with a kitchen knife or razor blade.
The devices range from about $5 to $10; Crosswhite recommends avoiding the cheapest models.
“If you’re going to do this, you need to invest,” he said.
And remember pill splitters don’t last forever.
“At some point, you will need to replace it,” Crosswhite said. “If the pills start crumbling, the razor may be getting dull.”