Articles on Pharmacy Benefit Management

Featured Health Business Daily Story Sept. 1, 2009

Some Health Plans Will Continue Pill-Splitting Programs Despite Recent FDA Warning of Risks

Reprinted from DRUG BENEFIT NEWS, biweekly news, data and business strategies for health plans, PBMs and pharmaceutical companies.

By Jill Brown, Managing Editor, (jbrown@aispub.com)

Some health plans say they will continue pill-splitting programs despite the FDA’s warning in July that pill splitting is a “risky practice.” But one payer says such programs have outlived their usefulness as generic drugs have come on the market for many key therapeutic categories.

The FDA on July 21 warned that pill splitting has grown more common as patients search for ways to save money in the recession. Since drug companies often charge the same amount for different sizes of tablets of the same medication, patients can receive two months’ worth of medication for the cost of a one-month supply by getting a prescription for a double-strength dosage and then splitting each pill in half.

But the FDA warned that some medications are difficult to split and may have different-size doses in each half. In addition, patients could get confused about the correct dose.

Joel Owerbach, chief pharmacy officer at Excellus BlueCross BlueShield, says he was “surprised” by the FDA’s recent consumer warning on pill splitting, “because they’ve been somewhat silent on this issue.” But, he adds, “I can appreciate why they did it,” given the increased usage of pill splitting. “I absolutely agree that anybody on their own should not be splitting their medications without talking to their pharmacist or their physician,” he says.

Excellus operated a successful pill-splitting program for several years, but now has phased it out, according to Owerbach. The program was limited to 20 drugs, and required a physician’s approval before the patient could participate. Patients had a lower copayment for drugs by participating in the pill-splitting program. Both patients and physicians liked the program, and in its heyday “30% to 40% of [prescriptions written for] the medications which we had in our program were being split.”

However, Owerbach says, “we don’t actively promote the program anymore.” That’s not because of concerns over the safety of pill splitting, he emphasizes, but instead because there are many more generic drugs available now in high-volume, high-cost categories. “In fact, the savings members get from using generics far exceed the savings from taking a brand-name drug and splitting it,” he says.

Other health plans are continuing with their pill-splitting programs.

UnitedHealthcare, Inc. says it will continue its Half Tablet program, but spokesperson Lynne High adds that the FDA advisory is consistent with its own recommendations to participating patients. “Individuals cannot participate without the permission of their physician,” she says. Since not all medications are suitable for splitting, UnitedHealthcare’s program covers only “18 medications for which there is no change in efficacy if they are split,” she says.

Not all the medications included in the Half Tablet program are designed to be split, UnitedHealthcare concedes on its HalfTablet.com Web site. “However, with the use of a tablet splitter, these medications may be appropriately divided.”

Under UnitedHealthcare’s program, the physician writes out a new prescription for twice the dosage and half the quantity, and notes that the patient intends to split the pills. Patients are subject to only half of their usual copay. Participation in the program is entirely voluntary, emphasizes UnitedHealthcare spokesperson Tyler Mason. He adds that a recent survey of 1,000 consumers conducted by UnitedHealthcare found that members save an average of $324 annually by participating in the Half Tablet program.

WellPoint, Inc. says it also has “no plans to change or discontinue our voluntary WellPoint NextRx pill splitting program.” Spokesperson Lori McLaughlin adds that “there are several studies that demonstrate pill splitting can be done safely. Our program includes a limited list of maintenance drugs that can be easily split and have been demonstrated to have good adherence and compliance rates.”

Similarly, Medical Mutual of Ohio says it will continue to offer “fully voluntary pill splitting on a limited number of pre-scored medications where exact dosages aren’t clinically important,” according to Benjamin Zelman, vice president of pharmaceutical management and business development.

The Academy of Managed Care Pharmacy (AMCP) has asked the FDA to “rescind and remove” the consumer warning from its Web site. AMCP contends that “supervised tablet splitting has been a long-accepted practice for flexible dosing, as part of a dose optimization strategy, or as a method to obtain a prescribed medication dosage when it is not available from the manufacturer.”

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