New York Times Examines Practice of Pill Splitting To Cut Prescription Drug Costs

The New York Times on Tuesday examined the trend of splitting certain high-dose tablets of drugs, which often cost the same per tablet regardless of dosage, resulting in "significant savings over time" for patients. While many people have long been splitting pills to address rising drug prices, the practice has in recent years been embraced by managed care companies. The Rochester, N.Y.-based Excellus BlueCross BlueShield said its voluntary program for splitting pills saved members in 2002 an average of $140 for each chronic medication. The plan saved the company $4 million, or about 1% of total drug costs. The 13 drugs and 26 strengths of medication Excellus approved for splitting were added to the plan based on recommendations from an advisory board of local medical professionals. Illinois' Medicaid program encourages tablet splitting by reimbursing pharmacies only for 100-milligram pills of Zoloft, which cost the same as the 50-milligram pills. State officials say pill-splitting saves the program about $3 million annually. Critics say pill splitting can be "tricky" and lead to errors in dosage or intake procedure, especially among patients who are elderly or have physical disabilities, the Times reports. A 2002 study, funded in part by the Veterans Affairs Medical Center in Asheville, N.C., found that doses deviated 9% to 37% from those intended among elderly patients who split tablets. The study concluded that larger deviations -- above 10% -- "could be hazardous" in some cases. A 2002 study by Stanford University Medical Center concluded that splitting the tablets of 11 commonly prescribed medications, when done properly, was safe and could result in drug savings of up to 50%. According to the Times, pill-splitting is expected to remain a popular practice even after the Medicare prescription benefit becomes available in 2006 because many patients will still have "substantial out-of-pocket costs" (Marino, New York Times, 4/13).