Split decision

February 21, 2013 9:49 AM

Is your wallet being gouged by the high price of medications? Cut that price in half. (pdf)

That 100 mg pill costs about the same as the 50 mg pill. With a quick snip you have two doses. When is this safe and when is it not?

posted by dances_with_sneetches (36 comments total)

That's a great idea. Something tells me the insurance companies will start adjusting their pills accordingly to try to block this.
posted by ThePinkSuperhero at 10:01 AM on February 21

Well, they could easily remove the scoring on pills to make them harder to split, or add an enteric coating to prevent it entirely. The issue here is that you're not necessarily going to get a uniform dosage of medication when you split pills in half. For any medications with a narrow therapeutic range, this can become seriously problematic over time.

The articles all say to check with your doctor before splitting pills to save money. That's really important advice.
posted by zarq at 10:06 AM on February 21 [2 favorites]

I don't think insurance companies care, but the drug companies do. From the Wikipedia link:

Not all tablets split equally well. In a 2002 study, Paxil, Zestril and Zoloft split cleanly with 0% rejects. Glucophage was described as a hard tablet, requiring significant force, causing tablet halves to fly. Glyburide exhibited very poor splitting with many splitting into multiple pieces. Hydrodiuril and Oretic crumbled. Lipitor did not split cleanly, and the coating peeled. The diamond shaped Viagra tablets made location of the midline difficult. The worst result reported was Oretic 25 mg in which 60% of tablets failed to split to within 15% of target weight.

I'm pretty sure that Viagra doesn't need to be in a diamond shape.
posted by dobi at 10:07 AM on February 21 [1 favorite]

There aren't that many drugs that have a sufficiently narrow therapeutic range so as to make them unsplittable. Those are discussed in the articles. More likely you'll run into the problem of taking a capsule or time-release or maybe you are already being prescribed the highest compounded dose.
posted by dances_with_sneetches at 10:10 AM on February 21 [1 favorite]

Another way to possibly save money on medication has been mentioned previously...
posted by Huck500 at 10:10 AM on February 21 [3 favorites]

Something tells me the insurance companies will start adjusting their pills accordingly to try to block this.

I got a letter this year from my insurance company suggesting that I look into splitting some pills, but since it's only a $10 copay it won't really save me much money (and I'm really too lazy to do it anyway.) I'll bet they would save a lot of money though...
posted by InfidelZombie at 10:11 AM on February 21

Or we could just not ban generic drugs to sell more expensive drugs.
posted by RobotVoodooPower at 10:13 AM on February 21 [4 favorites]

I've been doing this for like fifteen years. Glad to see Consumer Reports is still on the cutting edge.
posted by entropicamericana at 10:17 AM on February 21 [4 favorites]

Something tells me the insurance companies will start adjusting their pills accordingly to try to block this.

Insurance companies don't make pills.
posted by odinsdream at 10:18 AM on February 21 [4 favorites]

What about pill crushing and snorting? Is there any savings in that?
posted by wcfields at 10:18 AM on February 21 [10 favorites]

I got a letter this year from my insurance company suggesting that I look into splitting some pills

Yeah, my online pharmacy benefit portal Medco explicitely advised me to ask my doctor to double my dose and start splitting pills (because it saves the insurance company more money than it saves me). But I have this weird shame around cost-savings measures, so I'll probably go on spending $80 a year on generic medicine rather than $40.
posted by muddgirl at 10:21 AM on February 21

What about pill crushing and snorting? Is there any savings in that?

100%, after you die.
posted by Devils Rancher at 10:21 AM on February 21 [1 favorite]

What about pill crushing and snorting? Is there any savings in that?

100%, after you die.

Or just take an entire lifetime supply right NOW, before prices go up.

Savings: Incalculable!
posted by blue_beetle at 10:29 AM on February 21 [4 favorites]

But I have this weird shame around cost-savings measures, so I'll probably go on spending $80 a year on generic medicine rather than $40.

Just reframe it. Paying double for something means you will die having had less free time. So by saving money you're extending the part of your life that is worth living. Being smartly cheap == being more free.
posted by srboisvert at 10:43 AM on February 21 [2 favorites]

Something tells me the insurance companies will start adjusting their pills accordingly to try to block this.

I have a drawer full of plastic pill splitters from employees who though they were for stripping wire and that I'd be able to use them. They're old school Apple Bondi Blue and have our company insurance agency logo silkscreened on them.
posted by hal9k at 10:43 AM on February 21 [1 favorite]

My doctor is very aware of the issue of medication costs. Until the generic version of Lipitor became availble, instead of one 40mg tablet, he would prescribe me an 80mg and instruct me to cut it in half. Not quite a 50% saving but surprisingly close. Another medication he's having me take 1½ of a larger dose instead of 3 of a lower dose. It also shows he's serious about avoiding over-prescribing.
posted by oneswellfoop at 10:51 AM on February 21

Just reframe it. Paying double for something means you will die having had less free time. So by saving money you're extending the part of your life that is worth living. Being smartly cheap == being more free.

Except that she has to split the pills. If it takes her more than $40 of time to split the pills she's lost value.
posted by Jahaza at 10:53 AM on February 21

Eh, splitting a pill takes only a couple of seconds.
posted by ageispolis at 11:06 AM on February 21 [1 favorite]

Something tells me the insurance companies will start adjusting their pills accordingly to try to block this.

Not in every case. My copay is the same no matter what, but my old doctor had me using the pill cutter on half my prescriptions to save a bit for the insurer. New Doc just sneered when he heard, and rewrote them for half-sized pills, and now loading up the weekly pill case takes a fraction of the time.
posted by CHoldredge at 11:10 AM on February 21 [1 favorite]

From dobi's Wiki link: Not all tablets split equally well... The worst result reported was Oretic 25 mg in which 60% of tablets failed to split to within 15% of target weight.

IANAD, but 15% variance in a medicine I'm taking daily, with a 2-day average variance of 0%, is almost certainly trivial.

Case 1: the drug's halflife in your bloodstream is shorter than, or roughly equal to, the time between doses. Regardless of this 15% variance, blood levels vary by >=50% anyway.

Case 2: the drug's halflife is longer than the interval between doses. In that case each dose represents at most 67% of the total amount of the drug in your bloodstream (50% or more of yesterday's pill + 100% of today's pill), and so the 15% in the tablet only yields a 10% variance in your bloodstream - at most. Of course, in 23 hours those levels will probably drop more than that.

As for pills that don't split well, I mix them in a small vial of water, and drink it in two parts. Pills do not (in general) contain a nutrient supply suitable for bacterial growth.
posted by IAmBroom at 11:47 AM on February 21

The issue here is that you're not necessarily going to get a uniform dosage of medication when you split pills in half.

If you're splitting them approximately in half (100 mg into 50 mg plus or minus 3 to 5 mg per half) and taking both halves, one after the other, you're going to average out pretty close to exactly what was prescribed.
posted by pracowity at 11:53 AM on February 21 [1 favorite]

I think the bigger issue is not that one dose will be 45% and the other 55%, it's that one will be 45% and the other will be 45% (the other 10% is irretrievable powder/splittings). That's why I don't split my medication.
posted by fiercecupcake at 12:57 PM on February 21 [2 favorites]

Experts say that you shouldn't split pills on your own if you have:

Poor eyesight
Lost a limb
Tremors
Severe arthritis
Other medical conditions that could make accurate pill splitting difficult

WebMD comes through again!
posted by benbenson at 2:35 PM on February 21

I'm pretty sure that Viagra doesn't need to be in a diamond shape.
posted by dobi at 1:07 PM

Yeah, it would work better if it was shaped like a boner.
posted by orme at 3:10 PM on February 21

I've been doing this for like fifteen years. Glad to see Consumer Reports is still on the cutting edge.

Ha. I'm pretty sure they've been suggesting this for far longer than you've been doing it, too (family subscriber since the 1960s). If anything, they've evolved from advocating practical self-help techniques to lobbying on an industry-wide scale for better, fairer pricing and insurance coverage, compared to a generation ago.
posted by dhartung at 3:11 PM on February 21

Yeah, I've been doing this for a long time. Let me give you another tip which was recommended to me by my doctor.

Depending on your insurance copay, ask your doctor for a prescription for OTC medicines like Naprosyn or Aleve. I made a $4 copay and got 120 Naproxen 500MG tabs (prescription strength). Cut them in half for 240 doses at 250MG, which is close to the 220MG OTC dosage of commercial products like Aleve. I checked online and at 250 tabs of Aleve are about $20. So I got about $19 worth of Naproxen for $4.

Thanks, Doc!
posted by charlie don't surf at 4:35 PM on February 21

I used to take 100mg of a medication for $9 per 30 pills, and when I cut down to 50mg, the same exact medication cost $30 for 30 pills. I stared at the pharmacist blankly for a few minutes, and she said there was nothing she could do about it.
posted by phaedon at 4:39 PM on February 21 [1 favorite]

I tried this with instant-release Ritalin and those pills definitely don't have the same concentration of active ingredient in each half. Of course, that wasn't my only problem with instant-release Ritalin.
posted by subdee at 4:43 PM on February 21

I have found that pill splitting is very helpful for pain medication, particularly after surgery. It amazes me how terrible the average doctor or nurse is at modulating pain. For example, if they say you can have up to two pills every four hours, they look at you like you just invented the wheel if you suggest that you take one pill every two hours to keep a more constant dosage of pain relief going post-op.

Subject to talking through the issue with your doctor, if you go through surgery or have other pain medication needs, I suggest you try narrowing your windows between dosages and lowering overall dosages through pill splitting. You'll usually be a lot more comfortable with a lower, steady dose than if you spike a larger amount every longer period of time.

Then, as you start to lower your pain relief needs, draw out the taper with splitting again. I found I can split a relatively small, circular pill into quarters with a quality splitter. With this technique, I was able to get off of pain meds sooner with lower overall usage and less pain. Simple, but effective, common sense treatment.

Same goes for long term pain relief. If you have to take pain meds now and again, use splitting to find your minimum effective dosage and you'll be happier and more productive. Plus, I have a feeling it reduces the risks of addiction simply because you're taking no more than needed for the symptoms.

So, throwing out cost, splitting just makes sense and empowers you on your own treatment if you know what you are doing.
posted by Muddler at 5:07 PM on February 21

I am well acquainted with the pill splitter, because the smallest pill I can get here is 4× my dose. Bisoprolol 5mg are tiny things anyway, so I have to take squinty little corners of a nubbin of a thing. Plus, the inside tastes nasty.
posted by A Friend of Dug [sock] at 5:21 PM on February 21

If you are in BC you may also appreciate the pharmacy compass
posted by chapps at 10:49 PM on February 21

The diamond shaped Viagra tablets made location of the midline difficult.

This makes zero sense. Pick two points. Split in a straight line between them. Voila. A circular tablet without scores would be a lot harder to eyeball.
posted by charmcityblues at 12:48 AM on February 22

now the question, how do you get the doctor to prescribe you double the recommended daily dose? Won't they end up being liable if something happens and the split pill doesn't work as effectively as a whole one?
posted by any major dude at 7:41 AM on February 22

if they say you can have up to two pills every four hours, they look at you like you just invented the wheel if you suggest that you take one pill every two hours to keep a more constant dosage of pain relief

Yes and no... some meds require a certain dose to actually do anything. So halving the dose means you don't actually get over the hump, per se.

how do you get the doctor to prescribe you double the recommended daily dose?This is what I actually jumped on to point out. In the old world this was easy: the doc writes the instructions on a tiny piece of paper and handed it to the patient. The doc could, quiet literally, write anything they wanted to on there. So this was the process for everything from the highest prescribable doses of controlled narcotics to a note to get you out of work for a couple of days.

But in the new world, ruled by electronic check boxes, information that replicates itself multiple times, and overly cautious multi-tiered governmental regulations, it might be a bit of an issue. If the doc writes a 40mg prescription for you then that's exactly what the pharmacy sees. But if they write a 80mg prescription and ask you to cut it in half then it's totally dependent on the docs EHR system as to whether this would document on the patient's chart correctly. And that's not even taking things like JCAHO or NDC numbers into consideration, or the concept that a pharmacist essentially has the last say in something like this.

Caveat: I work on one of the largest EHR systems in the US, specifically with meds. On my system it would be possible to do this, but whether the pharmacist actually follows through is not always guaranteed. But most people I've talked to, docs, pharmacists, and everybody in between, seem pretty conscious of the fact that some people are more willing to go out of their way to save money than others. And most of them are pretty helpful when it comes to those sorts of things.
posted by Blue_Villain at 9:14 AM on February 22

Boy I really messed up the block quotes on that one, didn't I?
posted by Blue_Villain at 9:19 AM on February 22

Your arthritis doesn't have to be severe to make pill splitting a bad idea. Trufax.
posted by immlass at 12:15 PM on February 22 [1 favorite]