Splitting high-dose prescription tablets in half can
provide relief from high drug costs without affecting health adversely, a
University of Michigan study suggests.
The researchers there looked at the effect of splitting three high-dose
cholesterol-lowering pills in half. "Pill splitting did not make any
difference in adherence to the medications nor their cholesterol levels,"
says Hae Mi Choe, PharmD, a clinical assistant professor in the College of
Pharmacy at the University of Michigan, Ann Arbor, who is a researcher for the
study. The study is published in the June issue of The American Journal of
A pill that is twice the dose isn't typically twice the price, Choe says.
The higher-dose pills often cost only a bit more than the lower-dose ones. A
patient who needs a 40-milligram pill, for instance, might be able to split an
80-milligram tablet, doubling the supply and saving money.
Her team undertook the research because the cost of drugs can be a barrier
for patients. "Drug costs are an important determinant of whether patients
take the drugs or not," she says. This is especially true if patients are
on multiple medications, she tells WebMD.
Choe's team instructed 111 study participants who were on one of three
cholesterol-lowering medications to split the pills in half. The three drugs
were Lipitor, Pravachol, and Zocor.
She told half the participants they would get a 50% reduction in their
co-payment on each refill and the other half they would not, because she wanted
to see if the price difference would affect how well they stuck to their
medication schedule and their feelings about dealing with the minor
inconvenience of having to split the pill.
The average price reduction in the co-pay for each patient was $5 to $7 a
After six months, the researchers compared those who got a price reduction
with those who did not, asking about their willingness to continue splitting
the pills and also looking at how their cholesterol control had been
maintained. At six months, 109 of the 111 completed the survey.
"At the end of the study, we asked, 'Would you continue to pill split if
we gave you 50% off [your co-pay]," she says. "And 89% said yes they
For most, half off was enough, but 24% said they would only keep halving the
pills if the cost of the drugs to them was reduced to nothing.
A Model for the Future?
Both patients and the employers who insure them save money with
pill-splitting, Choe says.B A year after Choe's research was done, the
University of Michigan launched a formal pill-splitting program for employees
and retirees. In the first full year, the program saved the University
$195,000, Choe says, and saved participants more than $25,000 in drug co-pay
Choe is hopeful more insurers will adopt the co-pay reduction plan once they
hear about her study.
"Pill-splitting isn't for every drug or everyone," says Choe, who
advises consumers to ask their doctor or pharmacist before splitting any
medicines. People with manual dexterity problems, for instance, should probably
not try to split pills. Those with cognitive problems may forget to split pills
and end up taking too much medicine. Vision problems may make splitting too
Another expert takes a stronger stand. "From a safety standpoint, not
splitting is preferred," says Michael Gaunt, PharmD, a medication safety
analyst for the Institute for Safe Medication Practices in Huntingdon Valley,
Pa. "But there are situations where it may be necessary," he tells
For instance, if the dose the patient needs isn't commercially available,
the physician may advise him to split the tablet. Sometimes there are financial
reasons, Gaunt says.
Certain medications should not be split, Choe and Gaunt agree. Among
- Time-release or extended-release medicines should not be split, Gaunt says,
because it will affect the extended-release characteristics. With the coating
destroyed, you could absorb the medicine too quickly.
li>Pills with an enteric coating such as enteric-coated aspirin. When split,
Gaunt says, "it will lose the enteric coating and the enteric coating is
what helps prevent the tablet from dissolving in the stomach, so it decreases
irritation to the stomach."
"If there is not a good reason to split, don't," Gaunt cautions.
Technique, Buying Tips
If you do split -- with your pharmacist's blessing -- be sure to use a
medication splitter designed for the purpose, available at pharmacies and sold
over the counter, Gaunt says.B No kitchen knives allowed, he says.
Invest in a good splitter, Choe advises.B In the study, she gave
participants two commercially available splitters. She found that those that
were a little more expensive -- the mid range, about $5 -- worked better, as
did those with rubber matting at the bottom of the device to hold the pill.
Have you ever tried splitting
pills to save money on
your drug bill monthly? Did you consult your doctor? We're discussing this and
more on our Health Cafe: Meet Your Neighbors message board.
By Kathleen Doheny
Reviewed by Louise Chang
B)2005-2006 WebMD, Inc. All rights reserved