Pill splitting

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. 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).

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.

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, a frequently-prescribed cholesterol-reducing drug:

• 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, 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.

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 reasonably good eyesight and coordination, and it is one more 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 pills. For example, Illinois recently began encouraging Medicaid patients to do this with some drugs