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Pill-splitting could yield significant cost savings without compromising drug efficacy or safety, according to an article published in the American Journal of Managed Care.
Pill-splitting could yield significant cost savings without compromising drug efficacy or safety, according to an article published in the American Journal of Managed Care (vol. 8, no. 8).
"When properly implemented, pill-splitting can be a safe, viable cost-saving strategy," said Randall Stafford, a researcher at the Stanford Center for Research in Disease Prevention, Palo Alto, CA, and lead author of the article. "Physicians should consider using pill-splitting with selected medications and patients, and patients may want to bring it up with their doctors."
Using pharmacy claims data from a commercial managed-care plan in Massachusetts, Stafford and colleagues examined how often pill-splitting was used. They found the practice was relatively infrequent, accounting for annual savings of $6,200 in the health plan.
Researchers then used a systematic screening process to determine which medications were appropriate for pill-splitting, yielding a list of 11 commonly used medications that the researchers determined could be split safely and effectively with significant cost savings. The average potential savings for each drug ranged from 23% to 50%. Stafford calculated that if pill-splitting were fully implemented within the health plan he studied, the plan would save $259,500 annually.
The researchers emphasized that pill-splitting must be implemented with drug-specific and patient-specific criteria to ensure patient safety. Certain types of medications, including extended-release medications and those with enteric coatings, are unsuitable for pill-splitting, and certain patients, like those with poor eyesight, loss of a limb, tremors, debilitating arthritis, dementia or psychosis, may be unable to split tablets consistently and accurately. The researchers noted that results are best when the patient uses a pill-splitting device and is trained to use it.
Stafford explained, "We're not advocating this as a global solution. It needs to be conducted in the context of doctor-patient communication." He noted that the list of 11 medications he identified for pill-splitting isn't exhaustive and may differ depending on local practices and prices.
Though Jeff Trewhitt, a spokesman for the Washington-based Pharmaceutical Research and Manufacturers of America, said individual companies might have problems with pill-splitting, the industry as a whole was not opposed to the practice if it was implemented with care. "Pill-splitting is potentially dangerous if done by a patient unless it involves a collaboration between doctors and pharmacists who make sure that patients have been carefully screened and the medication is suitable for splitting," Trewhitt said. PR