Timothy J. Heady, CEO of UnitedHealth Pharmaceutical Solutions
Splitting prescription drug tablets can be one way for employers and employees to save on pharmacy costs, but only under the right circumstances.
Timothy J. Heady, CEO of UnitedHealth Pharmaceutical Solutions, a division of insurer UnitedHealthcare, spoke with SHRM Online about how prescription benefit plan managers can promote cost-conscious behavior via pill splitting. Take, for instance, the treatment of elevated levels of bad cholesterol (LDL) with cholesterol-lowering drugs in the statin family. Heady noted that his firm and other pharmacy benefit managers typically place the drug simvastatin (a generic statin marketed as Zocor) into tier one—with a minimum or no co-pay for many plans. But more expensive and heavily advertised brand name statin drugs, such as Lipitor and Crestor, are placed in tier two or higher, requiring consumers to pay more of the costs.
"Especially for plans with high levels of cost sharing for brand name drugs or high out-of-pocket deductibles, you would expect most people who could effectively manage their cholesterol by using generic simvastatin, by far the least expensive option, to do so. But there are individuals who with their physicians might have determined that they're having good success with Lipitor, for instance, and they don't want to move off Lipitor. In those cases, we are trying to provide tools to help them lower their costs, such as a "half-tab" program, where they can split their prescription tablets to cut their costs in half and stay on that therapy," Heady said.
Such a program can be designed with safeguards, "so that individuals can't just decide on their own, without the support of their physician, to split their medicines," he explained, noting that there are a limited number of medicines where splitting is appropriate. For example, splitting makes sense when the medication:
• Is in tablet form; capsules aren't going to work.
• Is not a sustained-release formula designed to be absorbed at various levels in the gastrointestinal tract, where splitting the tablet could compromise the integrity of absorption over time.
• Has a broad therapeutic performance range, so if consumers get a little more one day and a little less the next they won't compromise the integrity of the drug.
• Has flat pricing independent of the dosage.
Regarding flat pricing, Heady pointed out that in many plans a month's supply of Lipitor at 40 milligrams will cost the same as a month's supply at 20 milligrams. As a result, "when you split a 40 milligram tablet of Lipitor in order to take 20 milligrams a day, it's an absolute halving of the cost. It's meaningful."
Moreover, "once we determine that a particular drug meets all the clinical and safety requirements for splitting, we still require that the physician write the prescription stating that the tablets are to be split," and indicating that it's for twice the strength and half of normal quantity, Heady continued. "When it's presented to the pharmacy that way, our systems are programmed to collect half a co-pay from the individual. Or if the individual is paying 100 percent out-of-pocket, half of the cost. And we'll send these consumers a pill splitter."
As adoption of high-deductible benefit designs grows, Heady expects to see more use of pill splitting as an option, "because it is something that individuals can take control over themselves to significantly reduce their out-of-pocket costs," he predicted.
Insurers increasingly offer tools such as online portals that tell plan members whether a particular drug is appropriate for splitting. "Also, we communicate outbound to people who are using drugs that are appropriate candidates, to remind them that splitting is an option that's available," Heady said. "Then, we support them through different channels if they decide that this is something they want to do."
Experience, he added, has shown that "you can send out lots of information on ways that consumers can lower their drug costs, but most of it just gets lost because it's not relevant to them at the time. But a targeted letter campaign regarding tablet splitting for those who are already using a drug that's appropriate, noting that it's about an opportunity that's under their control, and explaining how they can pursue this if they would like—that gets a pretty good response," Heady observed.
"We've also begun using point-of-service messaging," he added. "If somebody presents a prescription for an appropriate drug, we encourage retail pharmacies to raise the issue of tablet splitting. We see a pretty good bump in the program when we arm retail pharmacists with information to support members who choose this option because they are interested in trying to help their customers."
However, pill splitting can mean that pharmacists cut their profit in half when they fill such prescriptions. "So we're looking at different ways to work with pharmacies and to compensate them," Heady said. "It's a win for everybody if they can help to take excessive costs out of the health care system. If they can help members to save money and be more compliant with their medicines, that's a good thing."
Stephen Miller is an online editor/manager for SHRM.
Individuals' Behavior Costs Billions Annually in Pharmacy Costs, SHRM Online Benefits Discipline, April 2010
Fact Sheet: Tablet Splitting Program, UnitedHealth Pharmaceutical Solutions
SHRM Online Benefits Discipline
SHRM Online Health Care Reform web page