Are cost savings worth pill-splitting risks?

With the cost of prescription drugs on the rise, several HMOs are asking their members to save costs by splitting their psychotropic medications in half, but the cost savings may not outweigh the risks, according to some doctors.

"This is not an automatically beneficial option to use for everyone," said Stephen Saklad, pharmacist and editor of Psychopharmocology Update. "If the patient has difficulty breaking the tablet, is cognitively impaired, or taking many medications in addition to the tablet to be broken, the cost savings may be an example of 'penny-wise and pound foolish.'"

According to Skalad, some medications lose their effectiveness when split in half. Some psychotropics are engineered with certain absorption characteristics, and if the tablet is destroyed this could cause increased adverse effects or decreased effectiveness. Other tablets may expire within days if the outer coating is cut and moisture is allowed in.

During a presentation at the annual meeting of the American Psychiatric Association, Carl I. Cohen, professor of psychiatry at the State University of New York Health Science Center at Brooklyn, determined that pill splitting could save an average of 37% of the cost of 12 psychotropic medications, but Saklad doesn't think the pill splitting solution is right for everyone.

"When the drug and the patient are both carefully selected, splitting a tablet can be a cost-effective strategy to employ," said Saklad. "However, the pharmaceutical company should reconsider their product pricing strategy and make the small tablets lower in cost to prevent the need to consider such practices."

It is not recommended that patients split pills with enteric coatings, which slow the breakdown of the medication in the body, or pills designated as time-release. PR