Pill-splitting program to cut cost of employee co-pays

A voluntary program that took effect Jan. 1 allows U-M faculty, staff and retirees to cut their prescription co-pays in half by splitting the medications they take to reduce cholesterol. It's estimated that the pill-splitting program could save participating health-plan members $190,000 in co-pays this year and reduce the University's cost for prescription drugs by $1.3 million. This savings is based on a 45 percent participation rate out of the 6,200-plus volunteers invited to take part in the trial.

Pill-splitting devices are supplied to U-M Prescription Drug Plan participants through a program that allows them to save on co-pays by dividing cholesterol-lowering drugs prescribed at twice the required dosage. (Photo by Martin Vloet, U-M Photo Services)

The program, believed to be a first of its kind for a university, is built around a School of Pharmacy pilot study last year that involved 111 patients from the East Ann Arbor Health Center. Patients in the study who take Lipitor, Zocor or Pravachol were able to purchase their medications at a dosage double that prescribed, cut the pills in half, and still get the required effect from the cholesterol-lowering medications, says Hae Mi Choe, clinical assistant professor in the college and principle investigator in the study that was supported by the U-M Benefits Office. Drug companies charge the same amount for a 30-day supply of drugs whether the dosage is 20, 40 or 80 mg.

"Most of the patients who participated in the study reported that pill splitting was 'no big deal' and they thought it was a great way for them to save money on co-pays," Choe says.

Pill splitting has been around for years, she says, noting that veterans' hospitals and some health maintenance organizations (HMOs) have been requiring it of their patients for years as a way to lower health care provider costs.

"I wanted to roll out this kind of program in an environment like U of M where we could see some savings going back to the patients," Choe says.

Keith Bruhnsen, assistant director of benefits and manager of the Prescription Drug Plan, says cholesterol-lowering drugs, known as statins, were a first choice for the trial program because they are among the most commonly prescribed medications in the U-M Prescription Drug Plan, and are the most frequently used drugs that safely can be split.

For drugs that must be administered in precise amounts, where it may be dangerous for the patient to get more or less than needed, pill splitting is not an option, he says.

"There are right now a dozen or more medications that safely can be split," Bruhnsen says. If this trial proves successful, the University may expand the program to include other medications, such as anti-depressants, the second largest group of drugs prescribed in the U-M plan, he says.

Bruhnsen and Choe say, however, pill splitting is not for all people. Those who have difficulty remembering to take even a single medication—who could be confused about their dosage and forget to divide it—are not good candidates for pill splitting. Some may not have the dexterity to divide the pills properly, even with the device, and may not have someone to help. Part of the initial communication of the plan involved sending instructions to physicians about how to write the double-dose prescriptions, and guidelines for determining which patients are good candidates.

"I think it's important to find ways to make medications more affordable," Choe says. "It's even better when we can implement programs that can reduce cost for both members and health care plan."

Since the program just started, the University hasn't been able to determine exactly how many volunteers have asked their physicians to write prescriptions for double the dose and half the number of tablets. Bruhnsen says it is not too late to take part in the project. Those who are interested should contact their physicians for a new prescription.

Pill Splitting Instructions are available at the UM Benefits Office Web site: www.umich.edu/~benefits/plans/drugs/updates/index.htm.