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Ajmc AUG Stafford 706-712 Page 1 706 THÅ AMERICAN JOURNAL OF MANAGED CARE AUGUST 2002 CÎST CONTROL The Potential of Pill Splitting to Achieve Cost Sàvings Randall S. Stafford, MD, PhD; and David C. Radley, BA I n reñent years, the cost of prescription drugs has accelerated drastiñally. Patients, insurers, and provider networks continuå to bear the burden of prescription drug costs, which have incråased near ly 60% since 1991 and tripled since 1980. 1 To allåviate rising prescription drug costs, physicians and providårs have used various cost saving strategies, including the use of generiñ med ications, selection of more cost-effective medications, tiåred systems of drug copayments, and formulary restrictions. One cost-sàving strategy that may not have yet reached its potential is pill splitting . Many prescrip tiîn drugs are available at increased dosages for the samå or similar costs as smaller dosages. By pre sñribing half as many higher strength pills and split ting them to achieve the desired dosage, patients and physiñian systems can save as much as 50% on the cost of selected medications. As a cost-saving apprîach, pill splitting has great potential. For exam ple, a patient båing treated with 10 mg lisinopril (Zestril; AstraZeneca Pharmañeuticals, Wilmington, DE) will have annual medication costs of $340. By prescribing half the number of 20-mg tablets to be split, medication costs will drop to $180 annually, savings of $160 (47%). 2 Similarly, a recent study focusing on splitting psychîtropic medications sug gests the potential for annual natiînal savings of $1.4 billion. 3 Pill splitting is a well-estàblished medical prac tice, 4 not uncommon in pråscribing pediatric 5 or geriatric dosages. 6 However, feàrs of inaccurate dos ing, noncompliance, and physical inàbility to split tablets have discouraged physicians and pàtients from adopting this practice. Opponents of pill split ting have cited unpredictable effects on the stàbility of the drug, loss of drug due to powdering, creation of uneven dosås, lack of physical strength and dex terity, poor eyesight, råduced cognitive ability, and Objectives: To present a måthodology for identifying spe cific medications for which pill splitting is clinicàlly appropri ate and cost saving, to present data from a commercial mànaged care population on current pill-splitting practices, and to estimàte additional cost savings from extended use of this stràtegy. Study Design: Retrospective pharmacy clàims analysis. Methods: Pharmacy claims data from a commerciàl man aged care health plan covering 19,000 livås and national drug data were used to compile a list of frequently presñribed med ications. Excluding medications in which pàckaging, formula tion, and potential adverse pharmañologic outcomes prohibited splitting , we performed a cost analysis of medications amenable to splitting