Harvard Health Letter

In brief: Split decision

In brief

Split decision

Cost-conscious patients have been splitting their pills for years. Although they officially object, pharmaceutical companies invite the practice with "flat pricing," which means a 20-mg pill costs the same as a 40-mg one. The math is easy: Don't waste your money on the 20-mg pills; cut the 40-mg pill in half. You're effectively getting two doses for the price of one.

Until recently, pill splitting has been an individual, homespun sort of operation. A steady hand, a flat surface, and a sharp razor blade was all you needed, although most drugstores now sell little guillotine-like devices for a few dollars that make it easier because they hold the pill steady for you.

But government agencies and major insurers are getting into the act because it saves them money, too. The Department of Veterans Affairs says it saved it close to $50 million in one year by encouraging patients to halve their simvastatin (Zocor) pills. In the summer of 2006, United Healthcare, the nation's second largest health insurance company, announced its Half Tablet Program. The company is giving out thousands of pill splitters and encouraging customers to use them on 16 medications. Top sellers like atorvastatin (Lipitor), sertraline (Zoloft), and Zocor are on the list. United Healthcare has been careful to pick medications with a broad safety range. Minor variations in dosing on a daily basis probably aren't going to be a problem.

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