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 the proper dosage. Obviously this is a dangerous practice, but impoverished patients have been known to do it.
• To save money, by deliberately purchasing tablets that contain twice the proper dosage and splitting them.

The phrase pill splitting sometimes refers to this third strategy. It is made possible by the fact that the price of a tablet 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.

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, and to avoid creating any financial incentives for choosing 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 (as opposed to having prices driven down to something close to their actual costs).

The practice is controversial. Drug manufacturers oppose it, partly for self-serving reasons, but partly out of serious concerns. 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.

Even when a pill is intended for splitting, reasonably good eyesight and coordination, and it is one more instruction that a patient needs to follow correctly.

Nevertheless, some insurers and large organizations are actively encouraging the practice of buying doubled doses and splitting pills. For example, Illinois recently began encouraging Medicaid patients to do this with some drugs