Viagra Pill
Splitting for Considerable Savings
The following
represent articles that address the topic of pill splitting:
An
Easy Remedy: Cut Your Drug Bills in Half by Cutting Pills in Half
Wall Street Journal
August 2001
Save
Money On Prescription Medications
Consumer Reports
May 2001
In
Cutting Drug Costs, Cooperation Is Key
Martin F. Downs, Medical Writer
Helping
Patients Avoid Hard Choices
Managed Care
December 2000
An Easy Remedy:
Cut Your Drug Bills in Half by Cutting Pills in Half
Wall Street Journal
(7/28/2001)
Looking for
ways to cut your prescription drug costs? Try buying bigger pills
and cutting them in half.
Pill splitting
is a deceptively simple way to save money on drugs, but few consumers
or even doctors are aware that it's an option. A quirk in the
way drugs are manufactured and priced means many drugs cost about
the same per pill, regardless of the dosage. As a result, patients
who buy a larger pill that contains twice the dose they need can
cut it in half and save as much as 50 percent.
For example,
Merck's cholesterol-lowering drug Zocor costs about $3.94 a pill,
whether the dose is for 20 milligrams or 40 milligrams. A patient
who needs a 20-milligram daily dose can cut a 40-milligram pill
in half, dropping the cost to just $1.97, saving more than $700
annually.
A patient
who needs a 75-milligram daily dose of Pfizer's antidepressant
Zoloft would pay $6.66 to take three 25-milligram pills. But splitting
a combination of 100-milligram and 50-milligram pills to achieve
a 75-milligram dose lowers the cost to just $2.53, a savings of
62 percent — or more than $1,500 annually. Given that many
older, uninsured patients have several prescriptions, the annual
savings from pill splitting can add up to thousands of dollars.
Detroit cardiologist
Joseph Rogers regularly counsels patients to split pills, and
dispenses the same advice through Rxaminer.com, a Web site offering
customized reports telling patients how to lower drug costs. "In
the United States, about $800 million worth of Viagra was sold
last year," says Dr. Rogers. "If everybody split their
pill, that would save $400 million. That's not going to solve
the whole problem of drug pricing, but it's a nice first step."
A typical
50-milligram dose of Pfizer's Viagra costs $8.20, the same as
a 100-milligram pill. Splitting the larger pill lowers the price
to just $4.10 a dose.
But splitting
pills as a way to lower drug costs is controversial. Some pills
— such as capsules or extended-release tablets — can't
be cut in half. If an extended-release pill is cut, for instance,
the slow-release mechanism is ruined and the patient may not get
any medication, or may end up getting the entire dose at once.
Even Dr. Rogers
advises that certain drugs for serious conditions, such as those
that prevent seizures or regulate heart rhythm, shouldn't be split.
Some pharmaceuticals
executives say it's dangerous to suggest pill-splitting as an
option for saving money, because consumers may become confused
and end up splitting the wrong pills.
"Once
you establish a precedent that medicine can be split, people might
make the mistake of splitting one that can't," says Mark
Horn, a physician and director of medical alliances for Pfizer.
"Sooner or later someone will get into trouble."
But it's the
way pharmaceutical firms manufacture and price their drugs that
makes pill-splitting possible. Many pills are "scored"
— manufactured with an indented line down the middle —
for the sole purpose of allowing them to be cut in half. Drug
firms score pills to give doctors flexibility to adjust a patient's
dosage.
In addition,
pharmacies can't stock dozens of different dose sizes, so drug
firms make pills in a few standard doses with score lines so they
can be split if necessary. Pill making is also a complex and expensive
process, and it's cheaper for drug companies to score pills than
to manufacturer a variety of doses.
Finally, many
drugs are flat priced — meaning they cost the same whether
the dose is 50 milligrams or 100 milligrams. Drug firms do this
because they want patients to get the most effective dose, and
they don't want cost to be a factor when doctors are deciding
how much of a drug to prescribe.
The result is a pricing loophole that gives patients a chance
to dramatically cut their drug costs. Last year, 80-year-old Marion
Budny of Grosse Ile, Mich., spent $2,400 on seven prescription
drugs. On the advice of Dr. Rogers, she will now split larger
doses of the drugs Lipitor, Cozaar and Norvasc for an annual savings
of about $700 off the national retail price. "Anything I
can save will be a big help," she says.
Not every
drug is flat-priced; some drugs do cost more in a larger dose.
But even then, patients usually can save money by splitting the
pills. For example, Merck's arthritis drug Vioxx costs $2.38 for
a 25-milligram dose and $3.44 for a 50-milligram dose. Splitting
the larger pill saves 28 percent, or about $240 a year.
Only a doctor
can prescribe a larger-dose pill, so patients must discuss pill-splitting
with a physician. To split pills evenly and safely, Dr. Rogers
suggests using a pill-splitting tool, rather than a knife. Mrs.
Budny paid $2.39 for a plastic pill-splitter at her local drugstore.
Although some
patients may worry that splitting pills will result in an uneven
cut and a dose that is slightly high or low, Dr. Rogers says those
variations rarely matter.
"There's
a lot of room to play with," Dr. Rogers says. "The drug
companies all say this is very specific, but there's a little
less science involved than what everybody is led to believe."
Save
Money On Prescription Medications
Consumer Reports May 2001
How much can
you save? Consumer Reports on Health, a sister publication, recently
sampled retail prices at six independent, chain, and mass-merchandiser
pharmacies in the Washington, D.C., area for two top-selling medications:
atorvastatin (Lipitor) and quinapril (Accupril), used to reduce
cholesterol and blood pressure, respectively. The potential saving
for quinapril was $105 per year; for atorvastatin, $120.
Not all companies
will match the best price you find. CVS stores wouldn't even match
cheaper drug prices we found on the company's own web site.
When you shop
for renewable prescriptions and non-rush orders, get prices from
a variety of retailers, including independent pharmacies and pharmacies
at supermarkets and mass-merchandise stores such as Costco Wholesale.
When you call, be prepared with the name of the medication, the
pill count, and the strength in milligrams (mg.).
But that's
not the only way to save.
Once a year,
bring all your drugs and nutritional supplements to your pharmacist
and physician so they can suggest any less expensive alternatives.
Sometimes inexpensive versions--including generics or older, well-established
drugs--work as well as newer, higher-priced drugs. The doctor's
review should focus first on whether you still need all your medications.
It's not unusual for a person to start taking a drug such as a
tranquilizer for a specific symptom and to keep taking it even
when it's no longer necessary.
Ask your doctor
for free samples, especially if you need a one-time supply of
a drug for, say, a bacterial infection. But avoid samples for
chronic conditions if it means continuing on a costly new drug
when cheaper, effective alternatives are available.
You can sometimes
cut costs by asking your doctor to prescribe a drug at double
dose so you can divide the tablets at home with a pill splitter.
For instance, both the 10-mg. and 20-mg. pills of lisinopril (Prinivil)
for high blood pressure cost about $27 for a 30-day supply. If
you need only 10 mg., you can buy the 20-mg. version and cut the
pills in half, saving $15 per month. But not all pills can be
split without compromising their effectiveness.
Some consumers
may be eligible for discounted drugs through state or drug-company
programs. Patients can apply through their doctor.
In Cutting
Drug Costs, Cooperation Is Key
Martin F. Downs, Medical Writer
We all know
prescription drugs prices can be astronomical, and it doesn't
look like they'll be coming down anytime soon. There are plenty
of clever ways to shave dollars and cents off the cost of your
medications, but experts say that simply cooperating with your
healthcare provider can save you--and everyone else in the United
States--more money than any gimmick can.
Perhaps the
most popular way to save money on prescription drugs is pill splitting.
The concept is simple, and it seems like an excellent idea: The
price of many drugs is the same at a higher dose as it is at a
lower dose. So you buy your medication at two times the dose you
need, then cut the pills in half, and save 50%.
But this "two
for one" deal is not for everyone. First of all, there are
many medications you absolutely cannot split. These include time-release
and coated pills, capsules, and any pill that is not scored down
the center. What's more, the practice has inherent hazards. "It's
extremely unwise in my opinion," says Frank Ascione, associate
professor of social and administrative sciences at the University
of Michigan College of Pharmacy. "The logistics involved
in doing that are pretty problematic."
Nicholas Popovich,
PhD, a professor of pharmacy at Purdue University, also warns
against pill splitting. "When you're dealing with the elderly,
who this would primarily help, the thing that you're always worried
about is if they're going to be able to adequately split it right
in half," he says. Not only do you risk cutting the pill
unevenly, you can also hurt yourself doing it, Popovich says.
If your hand
is unsteady and you'd rather not put your fingers in the way of
a razor blade, you can buy a special pill splitter at your local
drug store. But even if you use this device, you have to ask yourself
if you trust your memory. Popovich says many people, especially
the elderly, forget to cut the tablet in half and overdose.
Ascione says
some healthcare plans advise people to practice pill splitting.
"A number of managed-care companies are jumping on that bandwagon,"
he says.
Alan Korn,
MD, chief medical officer for the national network Blue Cross
Blue Shield, says his organization doesn't recommend it. "I
know of no Blue Cross plans that incorporate pill splitting in
any of the advice they give," he says. "It's a patient-driven
decision, not a plan-directed one."
But
Dr. Korn says he thinks there is one drug that's okay to split:
Viagra (sildenafil). He says people who take Viagra don't have
to follow a strict dosing schedule. If they split the tablets,
"so what?" he says. "They cut them up, and that's
fine."
Helping Patients Avoid Hard Choices
Managed Care
December 2000
There
are ways for low-income groups to avoid paying top dollar for
prescriptions. Here's one way physicians can educate consumers.
The rapid
escalation in the price of prescription drugs presents some patients
with a dire choice: filling a prescription or buying groceries.
Instead of skimping on food or skipping the rent, patients who
can't afford a copayment — or who lack a pharmacy benefit
altogether (the plight of many Medicare beneficiaries) —
may forgo filling the prescription you've just given them. They
may be too embarrassed to ever let you know about their financial
situation. Elderly patients are especially likely to be in these
straits.
Drug expenditures
have been increasing at an annual rate of about 15 percent —
faster than other components of health care spending. They account
for 8 percent of health care spending overall, but 10 percent
of seniors' health care expenditures. According to a study by
the University of Minnesota College of Pharmacy, annual spending
by the elderly for prescription drugs increased by 116 percent
between 1992 and 2000, rising from $559 to $1,205 per person.
Meanwhile, overall health care spending per elderly patient increased
by 59 percent.
Although it
could be argued that increased drug expenditures have helped hold
overall health care costs down, it nevertheless is true that people
on fixed or low incomes are in a financial bind. Their predicament
is likely to worsen, as more drugs (and more expensive drugs)
become available. In 1992, the average older American received
19.6 prescriptions annually at an average cost of $28.50 each.
By this year, it is expected that the elderly would receive 28.5
per person (average cost, $42.30), and by 2005, 34.4 per person
— at an average cost of $55.54.
The opposing
handout, which you may want to photocopy, provides information
for budget-conscious patients. Information about assistance provided
by states and pharmaceutical companies is readily available online.
Remind patients who don't have a computer that many public libraries
provide free Web access, along with assistance in using the computer
and searching for information.
Prescribing
a generic product instead of a branded one may help patients save
money. The Generic Pharmaceutical Association claims that every
1 percent increase in generic drug use results in savings of $1.16
billion. Generic drugs account for more than 40 percent of prescriptions
nationwide but less than 9 percent of drug expenditures.
If a branded
product is essential, the manufacturer may be able to provide
the drug free of charge. Member companies of the Pharmaceutical
Research and Manufacturers of America (PhRMA) maintain an online
directory. The alphabetical list of companies provides products
available, instructions for making requests, and eligibility criteria.
How To Save
Money on Prescriptions
Who doesn't
want to save money on prescriptions? Look below for some suggestions.
You can use the Internet to get telephone numbers and other details
about assistance programs provided by states and pharmaceutical
companies. If you don't have a computer, your public library should
be able to help you, free of charge.
Generic drugs
- if your doctor writes a prescription for a brand-name product,
ask if it can be replaced by a generic drug. Generics can save
up to 70 percent of the cost of branded prescriptions.
First-tier
products -if you belong to a managed care organization (MCO),
ask your doctor to prescribe a drug on the "first tier"
of its formulary (list of preferred drugs). That drug is likely
to be a generic product provided at no or very low cost. Drugs
on the second and third tiers involve copayments that can be substantial,
especially for products on the third tier.
Mail order
pharmacies - mail order pharmacies can provide substantial savings
over the cost of prescriptions filled locally. Be sure to order
only products that your doctor says you'll use for a long time.
Otherwise, if your doctor changes or stops your prescription,
you'll waste money. If you belong to an MCO, you already may have
received information about ordering drugs by mail. Otherwise,
you can go online to find mail-order pharmacies.
Pill splitting
- it may be cheaper to split, say, 100-milligram tablets in two
than to buy 50 milligram tablets. Ask your pharmacist about inexpensive
pill-splitting devices, and whether it is safe to split a given
product.
State assistance
- many states have pharmaceutical assistance programs for low-income
people (especially the elderly). Programs are available in California,
Connecticut, Delaware, Illinois, Maine, Maryland, Massachusetts,
Michigan, Minnesota, Missouri, New Jersey, New York, North Carolina,
Pennsylvania, Rhode Island, Vermont, and Wyoming. New or supplemental
programs will take effect in 2001 in Florida, Kansas, Maine, Massachusetts,
Nevada, and South Carolina, and Indiana has a new program whose
operational date has not been determined. Details are available
on the Internet at:
http://www.ncsl.org/programs/health/drugaid.htm
Indigent-patient
programs - about 50 drug companies provide certain products free
of charge to needy patients. Some companies make nearly all their
outpatient products available, but others are more restrictive.
In any case, your doctor must write a letter or submit a form
to request free prescription drugs for you.
