What medications are available for tablet splitting in the Half Tablet Program?

The list of medications available for tablet splitting includes:

The list of medications available for tablet splitting does not include all medications within a therapeutic class; only those medications determined to be appropriate for splitting are included.

Some of the tablets included in this program are not scored or designed specifically to be split. However, with the use of a tablet splitter, these medications may be appropriately divided. As is true with all medical decisions, you and your doctor will need to determine if the Half Tablet Program is right for you. Medications in the program will be reviewed periodically; additional medications may be included as appropriate.

What are the criteria for determining which medications are included in the program?

The UnitedHealthcare National Pharmacy and Therapeutic (P&T) Committee approved the following clinical criteria to determine prescription product inclusion in the Half Tablet Program.

• Medications with a wide margin of safety so that minimal differences in tablet sizes will not result in either underdosing or overdosing
• Tablets that can be split relatively evenly without crumbling
• Medications that will remain stable after splitting
• Medication must be available in “double” strengths that are comparably priced.

Medications with the following criteria are among those excluded from the program.

• Enteric-coated tablets
• Capsules, liquids, topical medications
• Unscored extended-release tablets
• Combination tablets in which the amount of one active ingredient changes from one tablet to the next, but the amount of the other ingredient does not

How does the program work?

If you fill a prescription for a medication included in the Half Tablet Program you will:

• Receive a notification letter in the mail informing you of the Half Tablet Program.
• Discuss the Half Tablet Program with your doctor. You and your doctor decide together if the program is appropriate for you. If yes, your doctor writes a new prescription for the higher-strength strength with instructions to take one-half tablet.
• Fill your prescription at a participating retail pharmacy.
• Receive an appropriate quantity (15 tablets to meet 30-day supply, 16 tablets to meet 32-day supply, or 17 tablets to meet 34-day supply) with instructions for using half a tablet.
• Follow instructions included in member notification letter for obtaining free tablet splitter or purchase one at a retail pharmacy.

How does the Half Tablet Program work at mail order?

You will receive 45 tablets to meet a 90-day supply at mail order. Because prescriptions are dispensed as written through mail order, you must obtain an appropriately written prescription for participation. The mail order pharmacy will not make outbound patient or doctor calls to initiate program participation.

How do I get my free tablet splitter?

UnitedHealthcare will provide you with one free tablet splitter by mail. Notification letters will contain a Participant Code which is required when ordering the tablet splitter on www.halftablet.com. Or, you can call 1-877-471-1860 to order your free tablet splitter. If you prefer, you may also purchase a tablet splitter at your local pharmacy, at your own expense. It is not covered by your UnitedHealthcare pharmacy benefit.

Can I still get a free tablet splitter if I don’t have a Participant Code?

If you haven’t received a letter, lost your letter, or do not have a Participant Code you can still receive one free tablet splitter by calling 1-877-471-1860. You will be asked to provide your UnitedHealthcare member number and your eligibility in the program will be verified. Not having a Participant Code may cause a delay in receiving your free tablet splitter.

How long does it take for my splitter to arrive?

Your splitter should arrive within 10 business days. Please do not call to check on the status of your tablet splitter until at least 10 business days. If you do not receive your splitter after 10 business days you may call 1-877-471-1860 for more information.

What if lose my tablet splitter? What if it breaks or wears out?

Tablet splitters are available for purchase at most pharmacies, at your own expense. It is not covered by your UnitedHealthcare pharmacy benefit.

What if I don’t want to participate in the program?

Participation in the program is entirely voluntary. If you do not wish to participate in the program, you may simply continue to fill your prescription as usual, taking the same strength. No action is required if you choose not to participate. If you try the Half Tablet Program and decide that it is not right for you, you may have your doctor write a new prescription for the old strength level and go back to your usual copay.

Have any studies been done on the safety and effectiveness of tablet splitting?

A number of clinical studies have been conducted on the safety and effectiveness of tablet splitting. These studies, published in peer reviewed medical literature, conclude that when appropriate medications are selected, tablet splitting delivers a safe and effective dose of medication. The following sections summarize two of the studies that have been conducted (please be advised the descriptions below are very clinical in nature).

Parra D et al. Effect of splitting simvastatin tablets for control of low-density lipoprotein cholesterol. American Journal of Cardiology 2005;95:1481-1483.
This is a retrospective evaluation of a voluntary simvastatin tablet splitting program in 6 VA medical centers. A total of 1,331 patients who were converted to split tablets and 2099 who were not converted were included in the analysis. Patients were converted from whole to split simvastatin tablets at the same total daily dose and issued a pill splitter and instructions about the conversion. Patients who had visual limitations or other disabilities were exempted from the conversion as were patients whose health care provider or pharmacist deemed them unable to perform the tablet Page 4 splitting. Primary endpoints were the average final LDL-cholesterol value and the average change from baseline between the split group and the whole tablet group. Secondary endpoints included comparison of total yearly simvastatin costs between groups, incidence of transaminase increases greater than 2 to 3 times the upper limit of normal and assessment of compliance. Baseline and final LDL-cholesterol levels and average change from baseline were not significantly different between groups (P>0.05), nor were the incidences of transaminase increases or measurements of patient compliance.

Gee M, Hasson NK, Hahn T, and Ryono R. Effects of a tablet-splitting program in patients taking HMG-CoA reductase inhibitors: analysis of clinical effects, patient satisfaction, compliance, and cost avoidance. Journal of Managed Care Pharmacy. 2002(8)6:453-58.
The primary objective of this study was to determine the effect of splitting atrovastatin, lovastatin, and simvastatin tablets on laboratory outcomes (lipid panel and liver enzyme tests). Other objectives were to assess patient compliance and satisfaction with splitting tablets and to measure the reduction in drug acquisition cost. Before entering the program, patients were evaluated by a prescribing physician or pharmacist for cognitive or physical barriers to assess whether or not hey were able to effectively split tablets. If patients agreed to participate, prescriptions were automatically converted by a pharmacist. A tablet splitter and instructions for use were provided free of charge to patients. A total of 2,019 patients were included in the trial conducted by a Veterans Affairs Health Care System facility. A total of 512 patients were eligible for the laboratory analysis. There was no difference between preintervention and postintervention laboratory values for total cholesterol and triglycerides. There was a statistically significant, but not clinically significant decrease in LDL (102 vs. 97, p<0.001) and increase in HDL (46 vs. 48, p<0.001), AST (26 vs. 28, p<0.001) and ALT (24 vs. 26, p<0.006) after the initiation of tablet splitting. A total of 454 patients responses to a mailed questionnaire (50%). Results showed that 84% believed that the tablet splitter was not difficult to use, 85% stated that split tablets were not harder to take compared to whole tablets, and 74% agreed that the tablet splitter was not too time-consuming or bothersome; 46% believed that it was easier to take medications when they did not have to split the tablets. Only 7% of the patients stated that tablet splitting had an effect on their willingness to take medications, and 7% stated that they missed more doses in a month while tablet splitting.

Other studies on tablet splitting include:

1. MA Veronin and B Youan. Magic bullet gone astray: medications and the internet. Science 2004: 305:481.
2. JM Rosenbergy et al. Weight variability of pharmacist-dispensed split tablets. J Am Pharm Assoc 2002; 42:200.
3. J Teng et al. Lack of medication dose uniformity in commonly split tablets. J Am Pharm Assoc 2002; 42:195.
4. JE Polli et al. Weight uniformity of split tablets required by a Veterans Affairs policy. J Manag Care Pharm 2003; 9:401
5. TJ Cook et al. Variability in tablet fragment weights when splitting unscored cyclobenzaprine 10 mg tablets. J Am Pharm Assoc 2004; 44:583
6. BT Peek et al. Accuracy of tablet splitting by elderly patients. JAMA 2002; 288:451
7. MC Duncan et al. Effect of tablet splitting on serum cholesterol concentrations. AM Pharmacother 2002; 36:205.
8. M Gee et al. Effects of a tablet-splitting program in patients taking HMG-CoA reductase inhibitors: analysis of clinical effects, patient satisfaction, compliance, and cost avoidance. J Managed Care Pharm 2002; 6:453.
9. JP Rindone. Evaluation of tablet-splitting in patients taking lisinopril for hypertension. JCOM 2000; 7:22.
10. RS Staffor and DC Radley. The potential of pill splitting to achieve cost savings. Am J Manag Care 2002; 8:706.
11. P Gupta and K Gupta. Broken Tablets: does the sum of the parts equal the whole? Am J Hosp Pharm 1988; 45:1498.
12. JT McDevitt et al. Accuracy of tablet splitting. Pharmacotherapy 1998; 18:193.