Rx: split decisions
There's something strange about pill prices: Bigger doses often cost no more than smaller ones. Say your doctor puts you on the cholesterol-lowering drug Lipitor. A bottle of 40-mg tablets will set you back just as much as a bottle of 20-mg pills, even though you're getting twice the medicine. These odd economics, and the soaring price of prescriptions, have a lot of patients asking a question: Why not just cut the bigger pills in half, and get twice as much medication for the money?
The savings are enticing. "Depending on the pill, patients could save between 23 and 50 percent a year," says Randall Stafford, an internist and epidemiologist at the Stanford Prevention Research Center in California who has studied pill splitting. But cutting medicine can also take a slice out of your health and safety. "Done incorrectly, the practice can endanger patient health," the current Journal of the American Pharmacists Association warns. It can lead to improper dosing and ruined pills. "You end up not getting the proper therapy, so you can get even sicker," says Thomas Cook, a professor in the pharmacy school at Rutgers-New Brunswick.
To cut or Nonetheless, patient interest is surging. So doctors and pharmaceutical researchers are starting to identify which pills can be safely split, based primarily on the type of coating and the way the pill acts in the body. And they're telling patients about the option. "I'd rather do this than prescribe the greatest medication only to find out later that patients aren't taking it because they can't afford it," says Mark Fox, a preventive cardiologist in Tulsa, Okla.
Patients can buy pill splitters at their local pharmacy, and unlike the pills themselves, they're cheap, $3 to$6. The devices are simple, with a plastic bottom tray to hold the pill and a top, equipped with a razor blade, that swings down to make the cut. Fox got on to pill-splitting through his 70-year-old father, who is on the statin Pravachol: "He's on Medicare and doesn't have drug coverage. I found that a bottle of 40-mg tablets costs $116 and 80-mg tablets cost $118. By splitting, he could get two months' worth for half the price." He now recommends splitting to most of his patients. (Odd-shaped pills, such as Pravachol, can be difficult to work with because they don't fit in the splitter securely. Precision Pill Splitters makes a device with beds custom-fit to many pills, but it costs $25.)
Pills often have similar prices for different doses because "the actual amount of the active chemical is a very small part of many pills. The bulk of the cost comes from packaging, advertising, and R&D, which are the same regardless of dose," says Stafford. Drug companies also try to keep prices similar because they don't want to penalize patients who need higher doses.
Once you've found a drug with this so-called flat pricing, the next step is to see whether it's amenable to splitting. You can eliminate prepackaged medications, like birth control pills, right off the bat. Capsules are another obvious no-no. The next feature to look at--and discuss with your doctor--is the safety of divided pills. Several studies have shown that pills don't split evenly, and the weight of each side can vary by more than 15 percent. That's a problem with pills in which slightly larger amounts provoke a much bigger response in your body. For example, the blood thinner warfarin can cause excess bleeding if you take too much of it, so it's not a good candidate for splitting. Extended-release pills, such as calcium channel blockers, can't be cut because the coating is key to the drug's gradual release.
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