Outside the Beltway

Insurer UnitedHealthcare Pushes Pill-Splitting Savings

James Joyner · Saturday, June 11, 2005 · 6 comments

Insurer Pushes Pill-Splitting Savings (AP)

The nation’s second-largest health insurer, UnitedHealthcare, is giving away away pill-splitters and offering half-price on drugs for those who split double-strength pills, cutting the patient’s insurance copayment in half. The company is also providing advice on which drugs can be safely cut in half.

“It has the potential for meaningful savings,” said Tim Heady, CEO of UnitedHealth Pharmaceutical Solutions, a division of UnitedHealthcare, based in Edina, Minn. “For every patient that chooses to reduce their costs by 50 percent, it would reduce ours and their employer’s cost by half of the cost of that prescription as well,” he said. “The question is how many consumers would be willing to participate.”

Crusty Texas attorney William J. Dyer (aka Beldar) thinks there is another question: “Are they really that stupid?”

He believes UHC is setting itself up for a massive lawsuit:

The doctors and pharmacists and drug company scientists will mount the witness stands to tell juries that yonder widow’s poor dead husband needed precisely X amount of drug Y each 12 hours — not roughly 4X divided roughly by 4, more or less at random. They will explain that coated pills cut into pieces and stored in steamy medicine cabinets lose their potency or have other unintended and unpredictable reactions. They will explain that the handy-dandy pill-cutters handed out by United Healthcare aren’t adequate substitutes for their FDA-mandated and -inspected manufacturing, measuring, and packaging processes. They will explain that they had good, indeed compelling, scientific reasons to formulate the dosages and schedules they did. They will explain how it was entirely foreseeable that some patients won’t have secured their physicians’ and pharmacists’ cooperation in prescribing and dispensing jumbo-sized dosages before the patients started cutting pills into pieces, so that instead of getting even roughly the intended dosages they only ended up getting a fraction of the intended dosage. They will explain how it was likewise foreseeable that many patients wouldn’t just cut up the specific pills suggested by United Healthcare, but would instead expand the practice to ultra-sensitive medications.

Think that’s too cyncial? Read down a few more paragraphs in the AP story and you come to this:

Among the 15 pills the insurer recommends splitting are expensive cholesterol drugs such as Lipitor, antidepressants such as Zoloft, and blood pressure pills such as Aceon and Diovan. Those pills can be split easily without any adverse effects, Heady said. “Say one day you get 30 percent of the tablet and the next day you get 70 percent,” he said. “What we’ve been able to determine is that doesn’t really have an impact on efficacy or safety.”

But Pfizer Inc., the maker of Lipitor and Zoloft, disputes that finding. Splitting a pill and leaving it in a steamy bathroom, for example, could change the nature of the drug, said the company’s Dr. Mark Horn. It amounts to an “unlabeled use of our medicines” that has not been rigorously tested, Horn said. “An experiment is being conducted on the people who are being encouraged to pill-split.”

The federal Food and Drug Administration does not regulate pill-splitting, but says there are risks such as forgetting to split pills, slicing time-release pills or unevenly breaking ones for which a precise daily dosage is needed. It is crucial to have the consent of a doctor, said Tom McGinnis, FDA’s director of pharmacy affairs. Doctors can judge whether a patient is capable of splitting pills, or whether they are likely to forego taking their medicine if they feel it’s too expensive. [emphasis added]

No good deed goes unpunished.

Full disclosure: UHC is my insurer. I’m not currently on any medication, although some have suggested that I should be.