One of least appreciated cost-savers in medical treatment is simple act of splitting pills. Suppose you're a U.S. citizen with depression who needs to take Lexapro brand of escitalopram oxalate, a commonly prescribed antidepressant, at a typical starting dose of 10 milligrams (mg) per day. Let's figure out how much your treatment will cost, both by month and by day.
For purposes of illustration I'll use prices shown online at drugstore.com. If you buy thirty Lexapro 10-mg tablets (which is how prescription is usually written) it will cost you $70.15 per month or $2.34 per day to get treated. But what if you buy Lexapro 20-mg tablets and take a half-pill each day? Medically, this treatment is same. But look what happens to unit prices. Thirty Lexapro 20-mg tablets cost $69.99. We need just 10 mg per day, so we split 20-mg tablets in half to make our 10-mg doses. (The tablets are even scored to make this easy.) In this case it costs you just $35.00 per month or $1.17 per day to get treated. Your daily price just dropped by half!
Isn't that amazing? And it's not just an isolated example. If you do a similar analysis for many other drugs, you'll find that taking half of a double-strength pill costs substantially less than taking all of a regular-strength pill. Or another way of saying this is that cost of a month's treatment is driven more by number of pills involved than by total number of milligrams taken.
Is this an accident of pricing? Should we be whispering about this? Is this pulling something over on drug companies? Hardly. If you think that multi-billion-dollar companies trading on New York Stock Exchange make pricing mistakes, then I've got some choice swamp-land in Florida I'd love to sell you.
So why would drug companies create these pricing mismatches (read: opportunities)? To understand this, let's walk through two prescribing scenarios. First, suppose a doctor is prescribing Lexapro to a patient who is lucky enough to have drug insurance. The patient pays a predetermined co-payment for each month's worth of medication, so he or she has exact same out-of-pocket expense whichever way prescription is written. So will doctor write for thirty 10-mg pills or fifteen 20-mg pills?
Your guess is probably right—the prescription will be written for larger number of lower-strength pills. The retailer and drug company will get full price. They're happy. The patient doesn't need to break tablets in half and doctor doesn't need to take time to explain why pills have to be broken, so they're happy. What's not to like? The only loser is insurance company. Do doctor or patient care? (Let's see, how many favors has insurance company done for doctor and patient lately?)
Now here's second prescribing scenario. Joe Workingman has no drug insurance and has to shell out cash to pay for full price of medication. The doctor feels that 10 mg daily of Lexapro is needed. This time, doctor prescribes fifteen Lexapro 20-mg pills per month, instructing patient to take a half-pill per day. Medically, there is no loss of efficacy. The patient is pleased to pay less money. The doctor is a hero for being thoughtful and clever. Because doctor still prescribed same product, drug company is happy. (The drug company would rather get half their price than nothing. Besides, they've already priced this scenario into their drug.)