Indiana's second-largest insurer, M-Plan Inc., welcomed some of its customers to the new year with a pill-splitting program that can chop prescription drug costs in half.
The Indianapolis-based health maintenance organization became part of a growing crowd of insurers endorsing a money-saving concept long practiced by doctors and patients.
However, pill splitting still stirs a healthy dose of concern over safety in some corners of the pharmaceutical world.
"I've had arguments with insurance companies about this for years," said Skip Tucker, owner of Tucker Pharmacy & Health Care of Indianapolis. "You know the old phrase, 'You're being pennywise and pound foolish'? That's exactly what we're talking about here."
A quirk in pharmaceutical manufacturing makes pill splitting possible.
Drugmakers generally charge the same price for a drug regardless of dose. They bear most of their cost in manufacturing and packaging a drug, not in dividing it by dose, said Nandita Das, an associate professor of pharmaceutics at Butler University.
This allows patients to save money by buying a higher dose of medication-with a prescription-then cutting the pills in half.
Cholesterol drugs, blood-pressure medications, some antidepressants and other treatments for chronic illness are among the drugs that can be split effectively, according to Dr. Jeffrey Kons, who practices at the IU Family Medicine office in the OneAmerica tower downtown.
Doctors frequently recommend pill splitting to patients with no pre- scription drug coverage.
The U.S. Department of Veterans Affairs also has endorsed the concept for years, said Alex Slabosky, CEO of The HealthCare Group LLC, which owns and operates M-Plan.
The practice is catching on with health plans, too. Nationally, United Healthcare is rolling out a voluntary program that allows pill splitting for 15 medications.
Indianapolis-based WellPoint Inc., the state's largest insurer, also has started a pilot program in Georgia to test it, spokesman Tony Felts said. He said the company has yet to draw any conclusions.
Despite this spike in popularity, Tucker called the concept a bad idea. His concerns center on safety.
For starters, patients without a specially designed pill splitter might try it with a sharp kitchen knife and a cutting board.
"I absolutely guarantee you you'd get one good half and the other half would wind up flying across a room somewhere," he said.
Even with a pill splitter, some medications can crumble when cut. Patients also might have sweaty palms or a damp kitchen counter, both of which will deteriorate the pill before it's swallowed, Tucker said.
People also can make a poor cut, noted Jeffrey Trewhitt, a spokesman for the Washington, D.C.-based Pharmaceutical Research and Manufacturers of America.
"Patients whose hands shake or have bad eyesight could have difficulty cutting precisely down the designated line and that could get them in trouble, and they should not be put in that position," he said.
The fact that elderly people consume most of the pharmaceuticals sharpens the focus on these concerns, said Matthew Murawski, associate professor of pharmacy administration at Purdue University.
"It's a good idea on paper," he said. "You just don't want it to be abused by asking your 83-year-old aunt to split a tablet."
Indianapolis drugmaker Eli Lilly and Co. shares some of those safety concerns. Spokesman Ed Sagebiel said any pillsplitting decisions should only be made "by a physician, patient and pharmacist working together."
Most of Lilly's tablet drugs are not scored or marked with a line down the middle for splitting and are not intended to be broken or divided, he said.
M-Plan's voluntary "Safe and Secure Rx Program" counters those concerns by emphasizing that both the doctor and patient have to determine whether the patient has the eyesight and steady hands to do it.
"The safety risk is more with choosing the appropriate patient," said Charles Mihalik, M-Plan's director of pharmacy services.
United Healthcare's Half Tablet program also depends on doctors' making the decision to allow patients to participate, spokeswoman Deborah Spano said.
"That is based on your mental facilities, your ability to remember that you have to split them," she said.
M-Plan provides a pill splitter a shade skinnier than a computer mouse for its customers to use. The plastic splitter's brackets and metal razor blade are designed to hold the pill and slice it squarely down the middle.
M-Plan also limits the program to seven drugs-including Zoloft, Lipitor and Crestor-because the insurer knows not every drug is suited for the program. Pill splitting, for example, doesn't work with time-release drugs or with capsules.
It also shouldn't be used for drugs that affect the central nervous system, Das said. Generic medicines tend to crumble or fall apart easier, so they also make poor candidates.
Mihalik said the drugs on M-Plan's list have either been used in other pill-splitting programs with no trouble, or studies have shown them to be effective even if they aren't split precisely.
"A health plan is not going to be eager to jump on the bandwagon until we have sufficient evidence to support the program," he said.
M-Plan hopes a few thousand of the 12,000 eligible customers enroll by the end of 2006. The insurer might consider expanding the list of drugs after it sees how the initial program fares.
Americans spent $230 billion on prescription drugs in 2003, and pharmacy costs have risen about 7.4 percent each year for the last 10 years, according to MPlan. That provides all the justification the health insurer needs to launch its program.
"We need to try everything we can to help better control the cost for our members, and this is just one of the things we're doing," Slabosky said.