Changes

Thus, a patient who needs a 20-mg dose can obtain 180 doses either by buying 180 20-mg tablets for $139.95<ref>2 &times; $73.97 = $147.94, but we are using $139.95 because this is the pharmacy's actual quotation for 180 tablets</ref>, or by buying 90 40-mg tablets for $74.97 and splitting them, a very significant savings.

Thus, a patient who needs a 20-mg dose can obtain 180 doses either by buying 180 20-mg tablets for $139.95<ref>2 &times; $73.97 = $147.94, but we are using $139.95 because this is the pharmacy's actual quotation for 180 tablets</ref>, 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. And, third, prescription drugs are a very inefficient market in which pharmaceutical manufacturers have the power to set prices almost at will.

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).<ref>[http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1480037 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."</ref> 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.

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.