The potential of pill splitting to achieve cost savings.
OBJECTIVE
To present a methodology for identifying specific medications for which pill splitting is clinically appropriate and cost saving, to present data from a commercial managed care population on current pill-splitting practices, and to estimate additional cost savings from extended use of this strategy.


METHODS
Retrospective pharmacy claims analysis.


METHODS
Pharmacy claims data from a commercial managed care health plan covering 19,000 lives and national drug data were used to compile a list of frequently prescribed medications. Excluding medications in which packaging, formulation, and potential adverse pharmacologic outcomes prohibited splitting, we performed a cost analysis of medications amenable to splitting.


RESULTS
Eleven medications amenable to pill splitting were identified based on potential cost savings and clinical appropriateness: clonazepam, doxazosin, atorvastatin, pravastatin, citalopram, sertraline, paroxetine, lisinopril, nefazadone, olanzapine, and sildenafil. For these medications, pill splitting is currently infrequent, accounting for annual savings of $6200 (or $0.03 per member per month), just 2% of the potential $259,500 (or $1.14 per member per month) that more comprehensive pill-splitting practices could save annually.


CONCLUSIONS
Pill splitting can be a cost-saving practice when implemented judiciously using drug- and patient-specific criteria aimed at clinical safety, although this strategy is used infrequently.
Stafford
Randall S
RS
Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, USA. rstafford@stanford.edu
Radley
David C
DC
D017046:Cost Savings / Q000379:methods*; D016527:Drug Costs / Q000706:statistics & numerical data*; D006801:Humans; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration; D008404:Massachusetts; D010349:Patient Compliance; D012189:Retrospective Studies; D012646:Self Administration / Q000379:methods*; D013607:Tablets / Q000008:administration & dosage* / Q000191:economics*
D013607:Tablets