Retirees often joke they will get in trouble if the HMO finds out they split their pills to save money, but now one of the nation's largest health insurers is pushing the idea.
United HealthCare, the nation's second largest insurer and among the largest in Florida, is the first major health plan to give discounts of up to $300 a year to members who split pills in half as a way to save on prescription drugs.
United executives said they have extended the offer of pill-splitting discounts to 13 million people who have company health policies at their workplaces, including about 1 million in Florida. That does not include Medicare recipients, but might in the future. So far, only 16 drugs are covered by the offer.
"You essentially get two pills for the price of one," said Tim Heady, chief executive of the company's UnitedHealth Pharmaceutical Solutions subsidiary. "The members can save money, the employers can save money and we can save money."
Of $8 billion in drug costs a year, United, based in Minnesota, said pill-splitting could save 1 percent, or $80 million. Of that, about one-third would go to consumers, Heady said.
Drug makers strongly oppose pill-splitting, but United is trying to cash in on a common pricing quirk of the drug business, in which manufacturers charge the same price for, say, a pill containing a 10 milligram dose as one containing 20 milligrams.
Manufacturers do that to dissuade customers from jumping to a competitor's pill if the doctor raises the dosage level, especially if the cost of making the drug is small compared with other costs.
For example, Walgreens charges $148 for 30 of Merck & Co.'s Zocor cholesterol-lowering tablets, regardless of whether the dosage is 20, 40 or 80 milligrams.
United's program lets members pay half the normal co-pay if they split their pills, Heady said. Paying $25 a month for a brand-name drug that normally has a $50 co-pay would save $300 a year. Consumers could save $60 or $150 a year for drugs with lower co-pays. They also get a pill splitter.
United tested the program in Wisconsin early in 2005 and found that 30 percent of people taking the 16 drugs participated, Heady said. During the first few months after extending the offer nationwide late last year, 11 percent participated, but Heady expects the number to approach 30 percent.
The pill-splitting discounts apply to the 16 drugs because United included only those that come in easy-to-split tablets, that have the manufacturer pricing and that physicians deemed would be effective even if the pills were not split perfectly, Heady said. That still includes blockbusters like the cholesterol drug Lipitor and the heart pill Cozaar.
Consumers can get the discounts only if the doctor writes a prescription for half-pills, preventing consumers from trying to go it on their own, Heady said.
"You don't want people to unilaterally split medicines when they might not know what they are doing," he said.
Several other health plans have encouraged pill-splitting as a way to cut costs for insurers and consumers, said Dr. Randall Stafford of Stanford University's Prevention Research Center in California.
"It can be a reasonable strategy for cost savings when drug costs are out of control," said Stafford, an associate professor of medicine.
Drug manufacturers oppose the widespread use of drug-splitting, saying there's not enough clinical evidence that the practice produces doses that are safe and effective.
Some manufacturers argue the main reason they put the same price on several different dosages is so patients will not switch to a too-low dosage solely to save money.
"Splitting pills can be dangerous for certain types of patients and for certain medications," said Jeffrey Trewhitt, spokesman for the Pharmaceutical Research and Manufacturers of America, an industry trade group.
Pill-splitting should be attempted only if the patient has enough hand strength to handle the pill cutter and has no memory impairment such as Alzheimer's disease, said Dr. Karl Dhana, medical director at the Joseph L. Morse Geriatric Center in West Palm Beach.
But Dhana said he has advised patients in some cases to halve their pills to cut costs.
"The bottom line is it's been done for years," Dhana said. "Doctors say, `Take a half of tablet.'"
Splitting is gaining a foothold among other health insurers. WellCare Health Plans, in Tampa, has no program or plans to offer one, but is "willing to support people doing this, assuming they have spoken to their doctor and pharmacist," said Heath Schiesser, the company's president of prescription drug plans. WellCare has 1.5 million members nationwide, most of whom are not elders.
Bloomberg News Service contributed to this report.
