Pill splitting

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Pill splitting means dividing a medicine tablet into two pieces, each containing half the dosage of the full tablet. An example would be breaking a 325 mg aspirin tablet into two halves, each containing about 162 mg.

Not all pills are designed to be split, and the production process is not necessarily designed to distribute the drug evenly within the pill; thus, even if the pill splits into two portions that appear equal in size, they may not contain equal quantities of the drug. Generally speaking, if the pill is not manufactured with a scored groove, it is not intended to be split.

Although grooved pills can be split with a knife and a steady hand, it is much better to use an inexpensive pill splitter (v.i.).

Pill splitting can be done for several reasons:

  • To obtain the correct dosage; for example, in some cases a doctor might advise a half-tablet dosage for a child.
  • To stretch out a supply of a drug when the patient cannot afford to buy enough tablets. Obviously this is a dangerous practice, but impoverished patients have been known to do it.
  • To save money on prescription drugs by deliberately purchasing tablets that contain twice the proper dosage and splitting them. (The practice requires the cooperation of the doctor prescribing the drug).

The phrase pill splitting often refers to this third strategy. It is made possible by a quirk of pharmaceutical economics: in many cases, the price of a tablet of a particular drug is almost the same regardless of the dosage. For example, one online pharmacy quotes these prices for simvastatin,[1] a frequently-prescribed cholesterol-reducing drug (and one that the VA considers suitable for splitting[2]):

  • 90 20-mg tablets: $73.97
  • 90 40-mg tablets: $74.97

Thus, a patient who needs a 20-mg dose can obtain 180 doses either by buying 180 20-mg tablets for $139.95,[3] or by buying 90 40-mg tablets for $74.97 and splitting them, a very significant savings.

This pricing pattern occurs for several reasons. First, drug companies say that they charge almost the same price regardless of dose as an ethical matter, to avoid creating any financial incentives for using anything less than the proper dosage. Second, the marginal cost of the drug in the pill is usually very small compared to the price of the pill (which needs to cover high development and marketing costs).[4] And, third, prescription drugs are a very inefficient market in which pharmaceutical manufacturers have the power to set prices almost at will.

The practice is controversial. Drug manufacturers oppose it, partly for self-serving reasons, but partly out of serious concerns. It is dangerous when a pill is not designed for splitting, or if it is a drug in which it is important for every dose to be precise. Even when a pill is intended for splitting, splitting requires reasonably good eyesight and coordination. It is also another instruction that a patient needs to follow correctly. Thus there is an increased danger of the patient making dosage mistakes.

Nevertheless, some insurers and large organizations are actively encouraging the practice of buying tablets with twice the appropriate dose and splitting them, for certain specific medications. The VA, for example, notes that "statins are a good candidate for tablet-splitting [because] the dose doesn't have to be as exact as with some other classes of drugs to be effective."[2] For example, Illinois recently began encouraging Medicaid patients to do this with some drugs,[5] while the University of Michigan supplies free pill-splitting devices and encourages students and faculty to take advantage of the practice as a way of saving on co-payments.[6]

Pill splitters

In the U. S. most pharmacies stock inexpensive[7] "pill splitters" or "tablet cutters" which split pills easily and reliably.

A pill splitter is typically a hinged pair of arms. The upper arm contains a blade. The lower arm contains a pair of spring-metal strips that hold the pill accurately centered under the blade. The blade and pill are placed near the hinge, providing leverage which makes it easy to apply a firm pressure. The device encloses the pill while it is being split, preventing the half from flying apart or getting lost.

Notes and references

  1. Simvastatin, drugstore.com.
  2. 2.0 2.1 Tablet-splitting Saves VA $46.5 Million on Popular Statin
  3. 2 × $73.97 = $147.94, but we are using $139.95 because this is the pharmacy's actual quotation for 180 tablets
  4. Use of a data warehouse to monitor Simvastatin Tablet Splitting, journal article: "Most drug companies include development, marketing and other costs in their pricing formula. As a result, the cost differential between various strengths of the same drug is often low or non-existent."
  5. Illinois asks Medicaid patients to split tablets to save money
  6. Pill-splitting program to cut cost of employee co-pays, University of Michigan Record online
  7. One online pharmacy show several devices with prices ranging from $3.29 to $6.59