There's
a way to cut prescription drug costs in half that few consumers
-- or even few doctors -- know about: buying bigger pills and
cutting them in half.
Looking for ways to cut your prescription drug costs? Try buying
bigger pills and cutting them in half.
Pill
splitting is a deceptively simple way to save money on drugs,
but few consumers or even doctors are aware that it's an option.
A quirk in the way drugs are manufactured and priced means many
drugs cost about the same per pill, regardless of the dosage.
As a result, patients who buy a larger pill that contains twice
the dose they need can cut it in half and save as much as 50 percent.
For
example, Merck's cholesterol-lowering drug Zocor costs about $3.94
a pill, whether the dose is for 20 milligrams or 40 milligrams,
according to DestinationRX.com, which compares retail and Internet
drugstore prices. A patient who needs a 20-milligram daily dose
can cut a 40-milligram pill in half, dropping the cost to just
$1.97, saving more than $700 annually.
A
patient who needs a 75-milligram daily dose of Pfizer's antidepressant
Zoloft would pay $6.66 to take three 25-milligram pills. But splitting
a combination of 100-milligram and 50-milligram pills to achieve
a 75-milligram dose lowers the cost to just $2.53, a savings of
62 percent — or more than $1,500 annually. Given that many older,
uninsured patients have several prescriptions, the annual savings
from pill splitting can add up to thousands of dollars.
But
splitting pills as a way to lower drug costs is controversial.
Some pills — such as capsules or extended-release tablets — can't
be cut in half. If an extended-release pill is cut, for instance,
the slow-release mechanism is ruined and the patient may not get
any medication, or may end up getting the entire dose at once.
Even
Dr. Rogers advises that certain drugs for serious conditions,
such as those that prevent seizures or regulate heart rhythm,
shouldn't be split.
Some
pharmaceuticals executives say it's dangerous to suggest pill-splitting
as an option for saving money, because consumers may become confused
and end up splitting the wrong pills.
"Once
you establish a precedent that medicine can be split, people might
make the mistake of splitting one that can't," says Mark
Horn, a physician and director of medical alliances for Pfizer.
"Sooner or later someone will get into trouble."
But
it's the way pharmaceutical firms manufacture and price their
drugs that makes pill-splitting possible. Many pills are "scored"
— manufactured with an indented line down the middle — for the
sole purpose of allowing them to be cut in half. Drug firms score
pills to give doctors flexibility to adjust a patient's dosage.
In
addition, pharmacies can't stock dozens of different dose sizes,
so drug firms make pills in a few standard doses with score lines
so they can be split if necessary. Pill making is also a complex
and expensive process, and it's cheaper for drug companies to
score pills than to manufacturer a variety of doses.
Finally,
many drugs are flat priced — meaning they cost the same whether
the dose is 50 milligrams or 100 milligrams. Drug firms do this
because they want patients to get the most effective dose, and
they don't want cost to be a factor when doctors are deciding
how much of a drug to prescribe.
The
result is a pricing loophole that gives patients a chance to dramatically
cut their drug costs. Last year, 80-year-old Marion Budny of Grosse
Ile, Mich., spent $2,400 on seven prescription drugs. On the advice
of Dr. Rogers, she will now split larger doses of the drugs Lipitor,
Cozaar and Norvasc for an annual savings of about $700 off the
national retail price. "Anything I can save will be a big
help," she says.
Not
every drug is flat-priced; some drugs do cost more in a larger
dose. But even then, patients usually can save money by splitting
the pills. For example, Merck's arthritis drug Vioxx costs $2.38
for a 25-milligram dose and $3.44 for a 50-milligram dose. Splitting
the larger pill saves 28 percent, or about $240 a year.
Only
a doctor can prescribe a larger-dose pill, so patients must discuss
pill-splitting with a physician. To split pills evenly and safely,
Dr. Rogers suggests using a pill-splitting tool, rather than a
knife. Mrs. Budny paid $2.39 for a plastic pill-splitter at her
local drugstore.
Although
some patients may worry that splitting pills will result in an
uneven cut and a dose that is slightly high or low, Dr. Rogers
says those variations rarely matter.
"There's
a lot of room to play with," Dr. Rogers says. "The drug
companies all say this is very specific, but there's a little
less science involved than what everybody is led to believe."
Helping Patients Avoid Hard Choices There
are ways for low-income groups to avoid paying top dollar for prescriptions.
Here's one way physicians can educate consumers.
The
rapid escalation in the price of prescription drugs presents some
patients with a dire choice: filling a prescription or buying
groceries. Instead of skimping on food or skipping the rent, patients
who can't afford a copayment — or who lack a pharmacy benefit
altogether (the plight of many Medicare beneficiaries) — may forgo
filling the prescription you've just given them. They may be too
embarrassed to ever let you know about their financial situation.
Elderly patients are especially likely to be in these straits.
Drug
expenditures have been increasing at an annual rate of about 15
percent — faster than other components of health care spending.
They account for 8 percent of health care spending overall, but
10 percent of seniors' health care expenditures. According to
a study by the University of Minnesota College of Pharmacy, annual
spending by the elderly for prescription drugs increased by 116
percent between 1992 and 2000, rising from $559 to $1,205 per
person. Meanwhile, overall health care spending per elderly patient
increased by 59 percent.
Although
it could be argued that increased drug expenditures have helped
hold overall health care costs down, it nevertheless is true that
people on fixed or low incomes are in a financial bind. Their
predicament is likely to worsen, as more drugs (and more expensive
drugs) become available. In 1992, the average older American received
19.6 prescriptions annually at an average cost of $28.50 each.
By this year, it is expected that the elderly would receive 28.5
per person (average cost, $42.30), and by 2005, 34.4 per person
— at an average cost of $55.54.
The
opposing handout, which you may want to photocopy, provides information
for budget-conscious patients. Information about assistance provided
by states and pharmaceutical companies is readily available online.
Remind patients who don't have a computer that many public libraries
provide free Web access, along with assistance in using the computer
and searching for information.
Prescribing
a generic product instead of a branded one may help patients save
money. The Generic Pharmaceutical Association claims that every
1 percent increase in generic drug use results in savings of $1.16
billion. Generic drugs account for more than 40 percent of prescriptions
nationwide but less than 9 percent of drug expenditures.
If
a branded product is essential, the manufacturer may be able to
provide the drug free of charge. Member companies of the Pharmaceutical
Research and Manufacturers of America (PhRMA) maintain an online
directory. The alphabetical list of companies provides products
available, instructions for making requests, and eligibility criteria.
Save
Money On Prescription Medications
Consumer
Reports May 2001
How
much can you save? Consumer Reports on Health, a sister publication,
recently sampled retail prices at six independent, chain, and
mass-merchandiser pharmacies in the Washington, D.C., area for
two top-selling medications: atorvastatin (Lipitor) and
quinapril (Accupril), used to reduce cholesterol and blood
pressure, respectively. The potential saving for quinapril was
$105 per year; for atorvastatin, $120.
Not
all companies will match the best price you find. CVS stores wouldn't
even match cheaper drug prices we found on the company's own web
site.
When
you shop for renewable prescriptions and non-rush orders, get
prices from a variety of retailers, including independent pharmacies
and pharmacies at supermarkets and mass-merchandise stores such
as Costco Wholesale. When you call, be prepared with the name
of the medication, the pill count, and the strength in milligrams
(mg.).
But
that's not the only way to save.
Once
a year, bring all your drugs and nutritional supplements to your
pharmacist and physician so they can suggest any less expensive
alternatives. Sometimes inexpensive versions--including generics
or older, well-established drugs--work as well as newer, higher-priced
drugs. The doctor's review should focus first on whether you still
need all your medications. It's not unusual for a person to start
taking a drug such as a tranquilizer for a specific symptom and
to keep taking it even when it's no longer necessary.
Ask your doctor for free samples, especially
if you need a one-time supply of a drug for, say, a bacterial
infection. But avoid samples for chronic conditions if it means
continuing on a costly new drug when cheaper, effective alternatives
are available.
You can sometimes cut costs by asking your doctor
to prescribe a drug at double dose so you can divide the tablets
at home with a pill splitter. For instance, both the 10-mg. and
20-mg. pills of lisinopril (Prinivil) for high blood pressure
cost about $27 for a 30-day supply. If you need only 10 mg., you
can buy the 20-mg. version and cut the pills in half, saving $15
per month. But not all pills can be split without compromising
their effectiveness.
Some
consumers may be eligible for discounted drugs through state or
drug-company programs. Patients can apply through their doctor.
A
MAN AGAIN': Experts praise a pill that treats impotence.(the
use of the Viagra, an impotence drug) Maclean's v111, n18 Maclean Hunter (Canada)
In
December, 1994, Lorne had just turned 40 and life was good. Married,
he had two young children, a house near Vancouver and a job he
enjoyed. Then disaster struck: as he changed a tire on his car
beside a roadway, another automobile hit him. Though Lorne can
walk and is about to go back to work, the accident damaged spinal
nerves and left him with enduring problems, including numbness
in some parts of his body and distressing limits on his sex life
due to difficulties having and maintaining erections. "It
was depressing," he recalls, "when my wife was in the
mood for sex and I just wasn't interested." Doctors suggested
remedies involving pumps and injections, but Lorne was not interested
in them. Then, he had the opportunity to take part in clinical
trials for a new drug called Viagra that is designed to deal with
problems like his. In December, 1996, Lorne began popping a sky-blue
tablet whenever sex was in the offing. Once again, his life was
transformed. "Sex is as good as it used to be-maybe even
a little better," he says. "This medication is just
fantastic."
Thousands
of American men appear to agree. Since Viagra was approved for
sale in the United States early in April, demand has soared to
the point that physicians are scribbling an estimated 40,000 prescriptions
a day. Manufactured by New York City-based Pfizer Inc., Viagra-which
has yet to be cleared for general use in Canada-can apparently
restore virility in about 80 per cent of men who have problems,
with only minor side-effects including headaches and indigestion.
"This isn't just another drug, it's the drug-the magic bullet
we've been waiting for," says Dr. Sidney Radomski, a urologist
at The Toronto Hospital, one of 27 Canadian centres that took
part in the clinical testing of Viagra. "It's going to revolutionize
the treatment of impotence."
Pfizer
developed Viagra after researchers testing a drug for angina found
that it triggered erections in men. Now, it seems destined to
largely replace existing treatments which-though effective-cause
many men to recoil in horror. The most popular method requires
a man who expects to have sex to use a needle to inject an erection-causing
drug into the side of his penis. Another involves using a vacuum
pump to draw blood into the penis to create an erection, then
placing rubber bands around the base of the organ to keep it erect.
"It was such a performance," says one middle-aged Viagra
user, who lives near Washington. Those methods, he adds, "undermined
erotic moments by taking the spontaneity out of sex."
Unlike
older treatments, which can leave men with erections that last
for hours if sex does not occur, Viagra only becomes effective
when a man is sexually aroused. The drug works by blocking the
operation of an enzyme that normally breaks down a chemical-cyclic
GMP-that plays a key role in maintaining erections. Even though
Viagra-assisted erections subside after intercourse, some men
report that the drug can remain effective for up to 24 hours.
"It means that when they have a sexual thought during the
day, they feel a physical response," says Dr. Rosemary Basson,
a sexual medicine specialist at The Vancouver Hospital, who has
prescribed the drug to 20 men as part of a long-term study. "That
says, OK, you're a man again. It's tremendously important to them."
At
the same time, U.S. doctors say some men who do not have potency
problems are using the drug to enhance their sexual performance.
There is no evidence that Viagra increases sex drive or staying
power, and at $14.50 per tablet, cost is a factor. Still, Dr.
Arthur Barnett, a urologist at Johns Hopkins Medical Center in
Baltimore, expects men will experiment with the drug "to
see if it will give them super erections or an increased number
of erections over a limited period."
While
experts estimate that about three million Canadians, including
perhaps half of all men over 65, have potency problems, many doctors
say the real number is unknown because so many males are unwilling
to discuss the issue, even with their doctors. That may be changing.
"Some patients who never told me they had a problem are asking
about Viagra," says Toronto physician James Brooks. "Now
that they think they won't have to mess around with pumps or needles,
they're coming out of the closet."
For
all its early promise, experts caution that Viagra's long-term
effects are not yet known. Moreover, the drug will not be a panacea
for every man who suffers from penile dysfunction-the medical
term that covers a wide range of potency problems. Some men, including
diabetics and those with diseases that cause serious neurological
or tissue damage, will remain difficult to treat, says Kingston,
Ont., urologist Jeremy Heaton. But for those who experience physical
arousal but still have performance problems, says Heaton, "Viagra
is going to be just great"-a judgment that Lorne and other
early users of the drug wholeheartedly endorse.
