UnitedHealthcare has yet to find a way to make pharmaceutical companies cut their drug prices in half. But in the meantime, it’s encouraging subscribers to cut costs in half the old-fashioned way – by splitting their pills.
United launched its “Half Tablet Program” in March of last year, as a pilot program in Wisconsin. The company was so pleased with the results that last fall it launched the program nationally, targeting fully insured members with prescriptions for statin medications.
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So far, about 650 Rhode Islanders have signed up, said Debora M. Spano, spokeswoman for UnitedHealthcare of New England. Nationally, about 11 percent of patients eligible for the program have signed up, she said, and United has given out 28,000 free pill-splitters.
The premise of the program is simple: Drug companies often charge similar or identical prices for different dosages of a medication. A month’s supply of Lipitor, for example, costs $103 on Drugstore.com whether you get the 20mg pills or the 40mg ones.
So if your prescribed dose is 20mg, and you buy the 40mg pills and split them, you can cut your drug costs in half – and save United and/or your employer some money as well.
“It’s another way for us to chip away at the affordability issue,” Spano said. “Until we get to true universal health care that guarantees everybody a certain amount of coverage, we have to come up with other solutions.”
To get people to sign up, United has sent out letters both to subscribers and their doctors, touting the benefits and stressing that it’s a strictly voluntary program. As a requirement of the program, a subscriber’s doctor must write a new prescription for double-strength pills and instructions to take a half-tablet. Doctors decide if pill-splitting is appropriate for each patient.
A recent United news release quoted Dr. Robert Fox, a family physician in Appleton, Wis., expressing support for the program:
“My patients appreciate the Half Tablet Program because the money they save on the reduced co-pays helps them to stretch their health care budget further,” he said.
“Patients are more likely to take prescribed medications when it is more affordable. That accessibility leads to better health outcomes, which is always my goal.”
The program is limited to a hand-picked list of drugs that United has deemed safe for splitting. Sixteen drugs are now on the list, including ACE inhibitors, angiotensin receptor blockers, anti-depressants, lipid-lowering medications and antivirals.
A couple more drugs will soon be added, Spano said, and all share a common trait: They can be taken in slightly varying doses without any negative effects. But even with those medications, United is being cautious – Medicare plan subscribers haven’t been included.
“We’re not comfortable with seniors and their abilities to split the pills physically, or to have the ability to make sure it’s done correctly,” Spano said.
But even with ordinary adult patients, pill-splitting is far from a universally accepted practice.
An “issue brief” from the National Association of Chain Drug Stores argues that splitting pills to save money “may provide cost savings in the short run, but the benefits may not outweigh the patient safety risks.”
Specifically, the group expressed concern about the lack of uniformity in dosage from tablet-splitting – because it’s impossible to cut a pill perfectly – which could be particularly dangerous with drugs with very narrowly defined dosages. Special coatings to protect the stomach and extended-release mechanisms could also be compromised, the group said.
Such concerns have kept Blue Cross & Blue Shield of Rhode Island from promoting pill-splitting, said spokeswoman Kim Keough.
“We understand that there’s a lot of discussion of pill-splitting” as a cost-cutting measure, she said, but the insurer’s medical experts worry that “the member could get too little one day or too much the next.”
“There’s also the risk that we’d send the message that it’s OK to split any drugs to save money,” Keough added, and that could be dangerous because some drugs should not be split at all. “We think that the effort to save drug costs should be focused on generic drugs.”
Asked for his take on the program, state Health Insurance Commissioner Christopher F. Koller said efforts “to engage consumers in managing the cost of health care” are “appropriate,” but United isn’t focusing its energy on the biggest issues.
“There are areas of greater waste and inefficiency that are built into the system, and health plans need to be addressing those areas as well,” Koller said.
