title: Evaluation of cost savings to a state Medicaid program following a sertraline tablet-splitting program.
abstract: OBJECTIVE
  To evaluate the economic impact of implementing a sertraline (Zoloft--Pfizer) tablet-splitting program on the Nebraska Medicaid program based on the change in total and per-member-per-month (PMPM) prescription drug costs and to identify any real or perceived problems with tablet splitting using switches among selective serotonin reuptake inhibitors (SSRIs) as a proxy indicator.
  
  
  METHODS
  Retrospective study of prescription claims before and after the tablet-splitting program was implemented.
  
  
  METHODS
  Nebraska Medicaid.
  
  
  METHODS
  All 14,520 patients who received an SSRI during the study period, including 5,466 patients who received at least one prescription for sertraline.
  
  
  METHODS
  The Nebraska Medicaid program implemented a mandatory tablet-splitting program for sertraline. Pharmacists were paid a supplemental fee to split tablets.
  
  
  METHODS
  Total costs, PMPM costs, and switches among SSRIs.
  
  
  RESULTS
  Using regression analysis, sertraline was the only SSRI that showed a downward slope in total cost per month, although the decrease was not statistically significant (P = .1156). Fluoxetine (Prozac--Eli Lilly) and paroxetine (Paxil--GlaxoSmithKline) both showed an upward slope, but the increases were not statistically significant (P = .1164 and .0671, respectively). Citalopram (Celexa--Forest) and fluvoxamine showed significantly positive upward slopes (P = .0001 and .0391, respectively). Sertraline was also the only SSRI that showed a downward slope in PMPM costs (P = .0093). Citalopram, fluvoxamine, fluoxetine, and paroxetine all showed an upward slope in PMPM costs (P = .4494, .0008, .0448, and .0482, respectively). The tablet-splitting program was not associated with a net change in patients being switched to or from sertraline.
  
  
  CONCLUSIONS
  Implementing the sertraline tablet-splitting program significantly decreased the PMPM cost of sertraline prescriptions, but it did not significantly decrease total costs of sertraline, nor did it result in disproportionate numbers of patients switching from sertraline to other SSRIs. Total costs and PMPM costs of the other four SSRI drugs did not decrease.
authors.affiliation: Department of Pharmacy Sciences, School of Pharmacy and Health Professions, Creighton University Medical Center, Omaha, Neb. 68178, USA. philv@creighton.edu
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Vuchetich
authors.forename: Robert I
authors.initials: RI
authors.lastname: Garis
authors.forename: Allison M D
authors.initials: AM
authors.lastname: Jorgensen
mesh_terms: D003363:Cost Control / Q000379:methods; D017046:Cost Savings / Q000191:economics*; D003625:Data Collection; D003866:Depressive Disorder / Q000188:drug therapy / Q000191:economics; D016527:Drug Costs; D011307:Drug Prescriptions; D006801:Humans; D008484:Medicaid / Q000191:economics*; D009329:Nebraska; D011306:Prescription Fees; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D020280:Sertraline / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D013607:Tablets
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline; D013607:Tablets