[india-drug] half the double dose saves money

[E-drug <e-drug@usa.healthnet.org>]

[Copied from Edrug. Thanks???..SS]


E-DRUG: half the double dose saves money
-------------------------------------------------
[interesting article from Wash Post on steps taken to save money: half
the
double dose!

Another version of this is that lower strength dosage forms sometimes
do
not exist: e.g., in South Africa one can only find hydrochlorothiazide
25mg or 50mg.
However,  BP control is fine with 12.5mg, while side-effects (gout) and
drug costs are lower! Industry is not interested to make new,
low-strength dosage forms that are not profitable.

Thanks to Druginfo for spotting this one. Copied as fair use. WB]

http://www.washingtonpost.com/wp-dyn/articles/A46222-2002Sep20.html

Ill. Medicaid Suggests Splitting Zoloft
Pfizer Backs Move to Prescribe Double Doses, Cut Pills in Half for
Savings
By Shankar Vedantam
Washington Post Staff Writer
Saturday, September 21, 2002; Page A06

In an unusual effort to keep costs down, the Medicaid program in
Illinois has decided to ask doctors to prescribe a double dose of a
popular antidepressant - which costs about the same as a smaller dose -
and then to tell patients to split the pills in half.

State officials said the measure would save about $3 million a year. It
came after the pharmaceutical company that makes the popular medicine
Zoloft implored officials not to remove the drug from the state's list
of preferred medicines.

"We were very cautious in going down this road and researched it after
Pfizer [Inc.] brought in the proposal," said Ellen Feldhausen, a
spokeswoman for the Illinois Department of Public Aid. "We were
skeptical."

Officials decided to take the step this week after Pfizer assured them
that the pills could easily be scored in half and would not lose their
potency, she said. The agency had not ruled out doing the same with
other medicines, if they met the same criteria, she said. Zoloft is
unusual in that 100-milligram tablets cost $2.79 -- about the same as
50-mg tablets that cost $2.73. "Instead of prescribing 30 50-milligram
pills, doctors can prescribe 15 100-milligram tablets," she said.

An official at the federal Centers for Medicare and Medicaid Services
in
Washington, who asked not to be identified, said that other state
programs were contemplating similar steps, in response to rising costs.
The official said there was no national policy yet on whether to
recommend such a move, and the agency was still weighing the safety
implications.

Health and advocacy groups were divided about the Illinois move, which
was first reported in yesterday's Chicago Tribune. Some patients with
physical or serious mental disabilities could be put at risk by either
not understanding how to get the right dose or not be able to split the
pills properly.

While the Illinois Medicaid program appears to be in the vanguard, many
individuals, especially seniors, have long resorted to pill-splitting
on
their own to control costs, some experts said. "We know it's happening
but we discourage that type of behavior," said Steven Hahn, a spokesman
for AARP, formerly known as the American Association of Retired
Persons.
"Following drug regimens as prescribed reduces relapses. It's something
patients should consult their doctor before doing."

"We learned 41 states are going to have to cut back their programs
under
Medicaid to control costs," he added. "The stories that people are
making daily choices between food and medicine are true."

Jeff Trewhitt, a spokesman at the Pharmaceutical Research and
Manufacturers Association of America, an industry trade group, said,
"Pill splitting is potentially dangerous if done by a patient unless it
involves a collaboration between doctors and pharmacists who make sure
patients have been carefully screened and the medication is suitable
for splitting."

The state will allow doctors to prescribe the 50-mg tablet if they
think a particular patient would be unable to cut the pills properly,
Feldhausen said. Pharmacists could cut pills for patients, she said,
but the state would not require them to do so.

Darrel Regier, director of the division of research at the American
Psychiatric Association, said asking patients to split the
antidepressant pills was less onerous than forcing them to take certain
medicines instead of others. "The major concern from a medical
standpoint is to preserve the flexibility for the individual tailoring
of treatments to the specific needs that an individual patient may
have," he said.

Regier said the Illinois development was unusual in that a
pharmaceutical company had come forward with the suggestion: "It's a
concession on the part of Pfizer to make this recommendation," he said.
"What they are doing by having the scored pills and suggesting this is
the way to go is recognizing you can treat someone at half the cost."


© 2002 The Washington Post Company





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