As drug costs have spiraled at a rate far greater than the overall inflation rate, Canadian drugs have emerged as one answer. Pill-splitting is a more nuanced approach. But it's not for everyone. And it works for only a handful of drugs.
Pill-splitting exploits a curious aspect of drug pricing. Some drugs come in more than one dosage without much difference in price. That means someone taking a 50-milligram dose of a drug could buy the 100-milligram version and cut the pill _ and maybe the price _ in half.
Pills that are scored, meaning they have a shallow cut across the middle, are ideal candidates for pill-splitting. Two slightly unequal doses that add up to 100 milligrams each day might work just fine.
Because medications have many subtle features that control their function, consulting with a doctor or pharmacist first is a must. Many medications can be undermined if cut open. Timed-released medications, for example, must remain intact.
"If you were physically able to split it . . . you might get it released in the wrong place in your body, which would mean it might be inactive or could cause you harm," said Susan Winckler of the American Pharmacists Association in Washington.
Also, pills encased in a hard coating in many cases should not be split, she said, noting that the hard coating might be there to mask a bad taste or to keep the contents intact.
Because pills rarely split 50/50, it's important to know how precise a medication's dosage must be. Some medicines are effective within widely varying dosages. Others, such as blood thinners, must be precise, Winckler said. A variance of 1 or 2 milligrams could lead to clots or to excess bleeding.
Not every pill, or pill-taker, is suited to this task. It takes dexterity and hand strength and visual acuity, Winckler said. And an ability to keep it straight, not an easy thing if you're taking five pills a day.
Some tablets are easily split by hand; others require a tool. Winckler favors a pill-splitter, a small device sold at pharmacies for a few dollars. Some work best with round pills, others with oblong pills. Since pill fragments can deteriorate, Winckler recommends cutting the pill just before you need it.
The bad news is that one study found that a group of elderly patients splitting pills produced halves that deviated from the intended dose by between 9 and 37 percent.
The financial incentive certainly is there. The average prescription price in the United States grew from $54.81 in 2002 to $59.28 in 2003.
Pills that split well
An article in the American Journal of Managed Care identified 11 drugs that can be divided, resulting in substantial savings.
Klonopim, Celexa, Paxil, Serzone and Zoloft (prescribed for anxiety and depression)
Cardura (for hypertension and enlarged prostate)
Lipitor and Pravachol (high cholesterol)
Prinivil (high cholesterol and heart disease)
Zyprexa (bipolar disorder and schizophrenia)