In pill splitting programs, patients ask their physicians to write prescriptions for double the dose and half the number of tablets for medications included in the program. Instead of taking one pill per dose, patients split the double dose pill and take one-half.

The UM pill splitting study, published in the June 2007 American Journal of Managed Care, adds evidence that splitting a double strength cholesterol-lowering pill is as efficacious as taking a whole dose pill. The study also found pill splitting had no adverse effect on adherence.

Researchers conducted a follow-up survey of UM employees who participated in a university pill-splitting study. That study found 89 percent were willing to continue splitting pills in exchange for a copay reduction. Most wanted at least a 50 percent copay reduction.

Statins are good candidates for splitting because they linger in the body for a relatively long time. In addition, small day-to-day fluctuations that can occur when pills are split don’t make a major difference in cholesterol levels.

Antidepressant medications also are good candidates for splitting. Drugs that exit the body quickly or have a time-release coating are not good candidates.

Pill splitting isn’t right for all members. Some will have difficulty splitting pills or remembering to do so because of cognitive or physical limitations. Pill splitting programs must be implemented with careful controls and member education. If the program is mandatory, it should exclude members who lack the skills necessary to participate.

UM Savings
Early in 2006, UM launched a voluntary pill-splitting program for three statin drugs. Participants received a 50 percent copay reduction and a free pill splitter. In the first year, the university saved $195,000 and 500 employee/retiree participants saved $25,000 in copay costs.

“If even 25 percent of eligible statin users split pills, the university would save $740,000 a year,” says Keith Bruhnsen, assistant director of benefits and manager of UM’s prescription drug plan.

Education is the biggest challenge, according to Bruhnsen. Members need to feel confident that pill splitting is safe and easy to accomplish. UM’s communication to physicians includes guidelines for determining which patients are good candidates for pill splitting as well as instructions for writing double-dose prescriptions.

“Community pharmacy buy-in also is a challenge because there are financial disincentives to the pharmacy,” says Bruhnsen.

If the pill splitting program for statins continues to be successful, UM may expand it to include other medications, such as antidepressants, according to Bruhnsen.

“Right now, there are a dozen or more medications that can be safely split,” says Bruhnsen.