Study: More than 50% of patients would split pills to save money

MINNEAPOLIS —If patient behavior over the last year is anything to go by, one of the biggest casualties of the economic crisis is medication compliance. According to a national poll released last month sponsored by health insurer UnitedHealthcare and conducted by Opinion Research Corp., 27% of people taking medications don’t take them as directed, including 18% who fail to take them altogether—practices that might save them money in the short term but could have devastating effects on their health.

But just more than one-third of respondents said they had asked their doctors or pharmacists about ways to save money on prescription drugs, such as tablet splitting. At the same time, according to the poll, 57% of patients would consider splitting tablets, but 9% of those taking tablets that can be safely split actually do so.

Many healthcare providers noticed the trend and responded accordingly, especially when higher-dosage pills cost the same as those of lower doses. “A lot of insurance companies and hospitals are stocking higher doses,” American Pharmacists Association media adviser and University of Cincinnati professor of pharmacy Bethanne Brown told Drug Store News. “[Patients] could ask their community pharmacist to split them if they have a relationship with their pharmacist, and [if] their pharmacist is willing to do that.”

UnitedHealthcare offers a voluntary tablet-splitting program that covers such drugs as Pfizer’s cholesterollowering Lipitor (atorvastatin) and Forest Pharmaceuticals’ antidepressant Lexapro (escitalopram oxalate). That, the company said, saved some customers almost $400 a year.

Cigna also offers a similar program, but encourages patients, when appropriate, to substitute generics for branded drugs, buy 90-day supplies instead of 30-day supplies and take higher doses at less frequent intervals.

But even experienced pharmacists don’t always get it right. “I think we probably introduce the same errors as a patient would,” Brown said. “We have a little bit more experience than patients. I think it’s just a risk in general in variations in amounts that patients would receive.” Brown said that using a handheld pill splitter can cause tablets to split unevenly, and many generic drugs simply will crumble under the blade.

According to a 2004 study published in The Medical Letter on Drugs and Therapeutics, trained pharmacists were, at best, able to split pills evenly two-thirds of the time. Powers Lake, Wis.-based TCGRx recently launched a tablet splitting machine that it said could split up to 16 tablets per minute with 2% variability between split halves.

Despite the risk of splitting mistakes, however, Brown said the practice had benefits. “I think sometimes it improves compliance because patients don’t feel they’re spending as much on their medications,” Brown said.