STANFORD, Calif., Aug. 29 -- Squeezed by the rising cost of prescription drugs, health plans and other health-care organizations are pursuing cost-saving strategies such as encouraging the use of generics, using narrowly tailored drug formularies and implementing multi-tiered co-payment systems.

Now, researchers at Stanford University Medical Center have confirmed that a less-common strategy - pill-splitting - could yield significant cost savings without compromising drug efficacy or safety. They emphasize that pill-splitting must be implemented with careful controls and begin with a doctor-patient conversation.

"When properly implemented, pill-splitting can be a safe, viable cost-saving strategy," said Randall Stafford, MD, PhD, a researcher at the Stanford Center for Research in Disease Prevention and lead author of an article published in the August issue of the American Journal of Managed Care. "Physicians should consider using pill-splitting with selected medications and patients, and patients may want to bring it up with their doctors."

The researchers emphasized that pill-splitting must be implemented with drug-specific and patient-specific criteria to ensure patient safety. Just as certain types of medications are unsuitable for pill-splitting - including extended-release medications and those with enteric coatings - certain patients may be unable to split tablets consistently and accurately. Such patients may include those with poor eyesight, loss of a limb, tremors, debilitating arthritis, dementia or psychosis. The researchers noted that results are best when the patient uses a pill-splitting device and is trained to use it.

Pill-splitting should be embarked upon only after a discussion between physician and patient, Stafford explained. "We're not advocating this as a global solution. It needs to be conducted in the context of doctor-patient communication." He noted that the list of 11 medications he identified for pill-splitting isn't exhaustive and may differ depending on local practices and
prices.
The researchers acknowledged that some physicians are reluctant to suggest pill-splitting because of concerns that patients may be unwilling or unable to split pills accurately. Stafford's research suggests that pill-splitting is likely to be safe and effective with appropriate screening, but he said further research is needed o this question.

He noted that pill-splitting would help those who pay for prescription drugs out-of-pocket, including the uninsured and some Medicare beneficiaries. For them, pill-splitting "may make newer, more expensive medications available to people who might not otherwise afford them."

Potential cost savings from pill-splitting:

Clonazepam [Klonopin]/Panic disorder; epilepsy/41 percent savings*

Citalopram [Celexa]/Depression/46 percent savings

Atorvastatin [Lipitor]/High cholesterol/33 percent savings

Paroxetine [Paxil]/Depression; anxiety/46 percent savings

Nefazodone [Serzone]/Depression/49 percent savings

Sertraline [Zoloft]/Depression/46 percent savings

Olanzapine [Zyprexa]/Schizophrenia; bipolar disorder/31 percent savings

*average potential cost savings of pill-splitting, in percentage terms, over varying dosages of each medication