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Pill Splitting Can Save Money, But Talk to Your Doctor First

IMAGE Does it seem that the price of your prescription goes up every time you refill it? 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 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. But be wary. Pill splitting may not be a good choice even if it means saving money. The Food and Drug Administration (FDA) advises against pill splitting, unless the drug label states that it is okay. Some concerns over pill splitting include:
  • Forgetting to split a tablet or being confused by the correct dose, which can lead to accidental overdose
  • Not splitting the pill evenly
  • Pills with unusual shapes or sizes may be difficult to split
Here are other concerns you should be aware of regarding pill splitting.

Splitting—Not Safe for All Drugs

In a 2002 study in American Journal of Managed Care, researchers 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.
The study 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

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 doctor. For some patients, pill splitting is unwise, resulting in uneven dosing and ineffective treatment. Patients who have the following issues may want to avoid pill splitting:
  • Cognitive impairment
  • Debilitating arthritis
  • Poor dexterity or eyesight
  • Recurring tremors
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.
The United States Food and Drug Administration does not recommend splitting the entire supply of pills at once. Only split one at a time.
Also, if you switch from one brand of medicine to another, you need to make sure that it is still safe to split the pills. Make sure to check the package to make sure that the pill is FDA approved to be split.
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.

RESOURCES

Familydoctor.org, American Academy of Family Physicians http://familydoctor.org/

The Food and Drug Administration, Center for Drug Evaluation and Research http://www.fda.gov/cder

CANADIAN RESOURCES

Healthy Living Unit (Public Health Canada) http://www.phac-aspc.gc.ca/

Canada Safety Council http://www.safety-council.org/

References

Best Practices for Tablet Splitting. United States Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/ucm184666.htm. Updated October 21, 2009, Accessed April 10, 2013

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.

Tablet splitting: a risky practice. United States Food and Drug Administration website. Available at: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm171492.htm. Updated July 21, 2009. Accessed April 10, 2013.

Winslow R. Study finds splitting pills usually safe, saves money. The Wall Street Journal Online. Accessed August 30, 2002.

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