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Sept. 3, 2002, 12:47 a.m. EDT

Pill-splitting prescribed

Money-saving measure validated by new medical study

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By Andrea Coombes, CBS MarketWatch.com

SAN FRANCISCO (CBS.MW) -- The practice of cutting high-dose pills in half to save on prescription drug costs won critical backing from a medical research study last week, yet drug makers continue to oppose so-called pill-splitting on medical-safety grounds.

Consumers can safely take half of a higher-dose pill instead of one lower-strength pill for 11 common medications, and they can save up to 50 percent in the process, according to the Stanford University Medical Center study.

The drugs, including Pfizer's Viagra and GlaxoSmithKline's Paxil, are safe for splitting, but only under a doctor's supervision. Many medications will not work if cut in half, and every patient's condition is different, the researchers said.

The study found that one health plan could save up to $260,000 if physicians prescribed split pills for the 11 drugs, because higher-dose pills often cost about the same as their lower-strength counterparts.

Drug-makers say they oppose pill-splitting because it's dangerous, and could lead to ineffective treatment.

"We go through very rigorous tests to determine how our products should be used and that information is very specific, approved by the FDA, and is made available in our package inserts," said Charles Alfaro, spokesman for Roche, manufacturer of Klonopin, which is on the study's list.

But drug makers' opposition to pill-splitting may be rooted in protecting profits as well, industry experts said.

"Their position, as they will tell you, is enunciated with the medical and clinical ramifications in mind, but it's transparent that it's also an economic decision by the industry," said Steven Findlay, director of research at the National Institute for Health Care Management, a non-profit health-care research foundation.

"If this trend were to pick up significant speed it could cut into the revenues and profit margins of the pharmaceutical industry because people would be buying a 30-day supply and getting a 60-day supply," Findlay said.

Pharmaceutical companies could react to an increase in halving pills by changing their price structures.

"If this practice were to truly become widespread throughout the health care system, maybe pharmacy companies would think twice about their current pricing structures for medication," said Dr. Randall Stafford, the lead author of the study and a professor at Stanford's Center for Disease Prevention.

GlaxoSmithKline spokeswoman Mary Anne Rhyne said the company opposed the practice because treatment may be ineffective at half-dose. The idea of changing price structure had "not been looked at," she said.

Pfizer, Inc. and Bristol-Myers Squibb Company did not return calls seeking comment.

The health plan studied by Stanford's researchers already realized annual savings of $6,200 because of current pill-splitting practices. Researchers reviewed pharmacies' prescription claims detailing how many tablets were doled out, and compared that number to how long each prescription was intended to last.

Both health plans and patients can realize cost-savings from halving pills, Stafford said.

"From a patient's viewpoint, if they're paying out-of-pocket there may be a reason to pursue this" with their doctors, Stafford said. "But before a pill-splitting prescription is written, it requires the patient and physician to have a frank discussion of whether this strategy makes sense for a particular medication and the patient's own situation."

The following are the 11 brand-name medications found to be safe for splitting, followed by the drug's name, its prescribed uses, and the average potential cost savings over varying dosages, according to the study:

Klonopin, made by Roche /zigman2/quotes/206948568/composite RHHVF +0.31% ; drug -- Clonazepam; panic disorder; epilepsy; 41 percent

Cardura, made by Pfizer, Inc. /zigman2/quotes/202877789/composite PFE +0.72% ; drug -- Doxazosin; hypertension, prostate enlargement; 46 percent

Celexa, made by Forest Laboratories, Inc. ; drug -- Citalopram; depression; 46 percent

Lipitor, made by Pfizer; drug -- Atorvastatin; high cholesterol; 33 percent

Paxil, made by GlaxoSmithKline /zigman2/quotes/209463850/composite GSK +0.84% ; drug -- Paroxetine; depression, anxiety; 46 percent

Pravachol, made by Bristol-Myers Squibb /zigman2/quotes/202559280/composite BMY +0.83% ; drug -- Pravastatin; high cholesterol; 23 percent

Serzone, made by Bristol-Myers Squibb; drug -- Nefazodone; depression; 49 percent

Viagra, made by Pfizer; drug -- Sildenafil; impotence; 50 percent

Zestril, made by AstraZeneca /zigman2/quotes/200304487/composite AZN +0.79% ; drug -- Lisinopril; congestive heart failure, hypertension; 38 percent

Zoloft, made by Pfizer; drug -- Sertraline; depression; 46 percent

Zyprexa, made by Eli Lilly and Company /zigman2/quotes/200106384/composite LLY +1.02% ; drug -- Olanzapine; schizophrenia, bipolar disorder; 31 percent

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