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Pill Splitting: Pros and Cons

Pill splitting can be a method for health plans and its members to save money, but has received some notoriety due to potential safety concerns. While pill splitting may be right for some, it may not be for everyone. Always consult with your pharmacist before splitting medication.

The biggest advantage to pill spitting is that it can be a cost-saving solution. It would be assumed a tablet twice as strong would be twice the cost, but due to some manufacturers’ pricing this is not always true. In fact, the higher strength pill might be about the same price as the lesser strength.  On the other hand, because medication is only effective when taken in the correct dose, at the proper frequency and for the appropriate period of time, improper pill splitting can alter the effectiveness of a prescribed medication.   Splitting pills can cause uneven “halves” or crushed tablets resulting in inaccurate, lost or wasted doses which can be costly. 

Safety and Pill Splitting

 

 

Certain splitting devices are better than others and every tablet is not able to be split.  Many medicines, because of their ingredients, dosage form or design, cannot be split safely. Splitting the wrong type of medications could be potentially dangerous.

Always consult with your pharmacist if you have additional questions about whether or not your medication can be split.  Only tablets that are scored or have a middle groove should be split.    Never break scored tablets with a knife or by pushing them against the edge of a counter.   

 

 

Drugs that should not be split:

     - Medication Capsules 

     - Drugs with an enteric coating, designed to protect the stomach. Once split, the interior of the pill could irritate the stomach,   

        leading to potentially serious problems.

     - Time-release or long-acting tablets. Cutting these pill destroys the time-release effect, which means too much of the medicine

        too quickly. Splitting a pill that has a long-acting release could possibly result in an overdose.

     - Controlled (or sustained) release tablets. These are designed to release vital ingredients over time. 

        Splitting them may result in a patient receiving a much greater dose sooner than expected. These pills are

        usually coated. By breaking the coating, the pill dissolves faster.  Example: Extended-release nifedipine

        (Procardia XL) for high blood pressure.

     - Critical dosage tablets. In some medications even a minor variance of dosage makes a difference and

        splitting could present that risk.  Example: Blood thinners such as warfarin (Coumadin).

     - Combination product tablets.  Medications that contain more than one drug may not have both

        medications evenly distributed

        throughout the tablet.  Example: Valsartan and hydrochlorothiazide (Diovan HCT) for hypertension.

     - Prepackaged drugs in specific doses. 

        Example: birth control pills.

 

Other Pill-Splitting Risks:

Splitting a tablet unevenly results in two pieces with very different dosages, neither of which is accurate. If a tablet is crushed into a powder this also results in potential inaccurate dosing and must be disposed of.

Is Pill Splitting Worth It?

In 2006, the University of Michigan started a pill-splitting program.  The university estimated that they saved $195,000 and members saved over $25,000 in drug costs during the first year.

Though there is no doubt pill splitting, when done properly, can save some money on prescription drugs,  people taking medication that cannot be safely split or who are uncomfortable with the idea, or feel like it is too much of a hassle should not be concerned about splitting tablets.  But for others, pill splitting may offer a two-for-one bargain that does not affect their dosing.

IPC’s Stance

IPC does not actively encourage pill-splitting programs as there are other ways to manage costs without jeopardizing the dose integrity of the covered medication.  Pill-splitting can cause a miss-dosing of medication and may not be worth the potential savings.  It is always important to check with your pharmacist to determine if splitting all or some of your medication will work for you.

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