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[e-drug] half the double dose saves money

  • Subject: [e-drug] half the double dose saves money
  • From: e-drug@usa.healthnet.org
  • Date: Tue, 24 Sep 2002 06:50:23 -0400 (EDT)

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]


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

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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