Editorial: Splitting pills isn’t a panacea

Thursday, Oct. 28, 1999 | 9:54 a.m.

Prescription pill prices have skyrocketed in recent years. President Clinton is so alarmed that this week he ordered the first federal study of drug prices and the impact it has on the elderly. While the president is focusing on those who receive Medicare drug benefits, the rising costs of prescription drugs is hitting all Americans -- regardless of age. Health insurers, too, have felt the pinch since they must pay for a portion of the prescriptions ordered by physicians.

In response, some health insurers are seeking ways to trim these costs. One controversial method is requiring that doctors prescribe double doses of some medications. Patients then use a pill splitter, provided by the health insurer, to cut the medication in half. Since there isn't much difference in the price for either a single or double dose of certain medications, some insurers have opted for this route that saves them money.

Physicians and patients, though, say this policy is fraught with problems. Patients with arthritis or other debilitating conditions can experience difficulty cutting the pills, sometimes breaking them in the process, which ultimately wastes the medication. Another downside that has been cited is that some medications -- no matter how evenly cut -- lose their potency once split. Concerned about this trend, the state Pharmacy Board will consider regulations at its Nov. 4 meeting that would prevent insurers from refusing to pay for single-dose prescriptions.

Health Plan of Nevada, which requires pill splitting for some drugs, contends that it already allows doctors to request single doses for those unable to manage the pill-splitting tool. But as the Sun's Shaunta Grimes reported Monday, that was the first time Jeffrey Cichon, president of the Clark County Medical Society, had heard of this in the six months since Health Plan of Nevada has been requiring pill splitting. This confusion between the health insurer and physicians, while not uncommon in today's managed care world, shows why regulation in this area is essential.

While it is understandable that health insurers want to defray the increasing costs of prescription medications, putting in place a plan that eliminates a physician's discretion is wrong. Even if Health Plan of Nevada does continue a policy that gives the physician the ultimate discretion, without a regulation in place there would be no way to ensure that other insurers don't tie the hands of physicians. Tinkering with medication dosages is a risky business, so the state Pharmacy Board should adopt a regulation that makes sure the doctor -- not the insurer -- remains in control of these important medical decisions.