Pill Splitting Can Save Money, but Talk to Your Doctor First
Does it seem that the price of your prescription goes up every time you refill it? In fact, drug prices have risen 60% since 1991. For those who pay for prescriptions out-of-pocket or have capped prescription coverage, the rising cost of necessary medicine is troubling.
However, people who take some of the most commonly prescribed drugs may be able to reduce costs. A recent study in the American Journal of Managed Care explored the practice of pill splitting. Pill splitting saves money because the per-pill price usually does not vary significantly according to dosage. This is how it works: your doctor writes a prescription for a dosage level twice that of what you need. Then you split the pills in half and you end up with twice as many pills for the same price.
Doctors have commonly recommended pill splitting to prescribe smaller doses of medicine for children or the elderly, but few patients or doctors have used this strategy on a regular basis as a cost-saving strategy.
Splitting—Not Safe for All Drugs
Randall S. Stafford, MD, PhD, and David C. Radley, BA, studied if pill splitting can reduce the cost of drugs without compromising their safety and effectiveness. They also set out to identify the drugs that are most appropriate for splitting. These researchers examined the pharmacy records of a managed care plan at Massachusetts General Hospital in Boston.
Stafford and Radley determined the 265 drugs most frequently prescribed at the study hospital and nationally. About half of these drugs cannot be split. These include drugs with the following characteristics:
- Those manufactured as capsules
- Drugs available in only one dose
- Medicines that are not taken orally, such as ]]>asthma]]> drugs administered by inhaler
- Prepackaged pills, such as birth control pills
- Those that cannot easily be broken
- Pills with an enteric coating, which allows the drug to remain whole until it passes through the stomach to the intestine
- Any medicines that are extended release
Pill splitting is also not appropriate for drugs that metabolize quickly in the body and those that are effective only when blood levels must remain constant.
Which Drugs Can Be Split Safely?
Stafford and Radley developed a list of 11 commonly prescribed drugs that can be split safely, and for which splitting results in substantial cost saving.
The drugs identified in the study include the following:
- Six prescribed for psychiatric disorders, primarily ]]>depression]]>:
- Two for lowering blood cholesterol levels:
- Two for treating ]]>high blood pressure]]>:
- ]]>Sildenafil (Viagra)]]>
These drugs are manufactured in two or more dosage strengths. The costs of dosages differ very little or not at all. Almost three-quarters of them are scored, which makes breaking them easier.
Patients who split pills can save as much as 50% on the cost of a one-month prescription. For example, a man who takes 20 mg of Paxil daily can split a 40 mg tablet and buy just 15 tablets each month instead of 30. For people who regularly take more than one drug, the savings can make a big difference in their budgets.
Talk to Your Doctor Before You Split Pills
Do not split pills without first discussing the safety of the practice for each of your medications with your primary care doctor. For some patients, pill splitting is unwise, resulting in uneven dosing and ineffective treatment. Stafford and Radley recommend against pill splitting for patients who have the following issues:
- Cognitive impairment
- Debilitating ]]>arthritis]]>
- Poor dexterity or eyesight
- Recurring tremors
Pharmacists may be willing to split pills for you if they feel that they can do so accurately. Some states have regulations that do not allow pharmacists to split pills, but several states, including Massachusetts, New York, and California, do not.
If you are going to split pills regularly, invest in a pill splitting device. They are easy to use and allow you to split pills quite accurately. Your pharmacist can show you how to use it.
If you and your doctor decide that pill splitting is a good strategy for you, you may be able to save a good portion of the money you are now spending on medication.
Familydoctor.org, American Academy of Family Physicians
The Food and Drug Administration, Center for Drug Evaluation and Research
Healthy Living Unit (Public Health Canada)
Canada Safety Council
Choe HM, Stevenson JG, Streetman DS, Heisler M, Sandiford CJ, Piette JD.Impact of patient financial incentives on participation and outcomes in a statin pill-splitting program. Am J Manag Care. 2007 Jun;13(6 Part 1):298-304.
Cohen CI, Cohen SI Potential cost savings from pill-splitting of newer psychotropic medications. Psychiatr Serv. 2000 Apr;51(4):527-9.
Cross M.Two for the price of one beauty of pill-splitting catches on. Manag Care. 2003 Feb;12(2):36-8. No abstract available.
Miller DP, Furberg CD, Small RH, Millman FM, Ambrosius WT, Harshbarger JS, Ohl CA.Controlling prescription drug expenditures: a report of success. Am J Manag Care. 2007 Aug;13(8):473-80.
Physicians Desk Reference. 56th ed. Montvale, NJ: Medical Economics Company, Inc; 2002.
Stafford RS, Radley DC. The potential of pill splitting to achieve cost savings. The Am J Managed Care. 2002;8:707-712.
Winslow R. Study finds splitting pills usually safe, saves money. The Wall Street Journal Online. Accessed August 30, 2002.
Last reviewed April 2009 by ]]>Marcin Chwistek, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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