Mandatory tablet splitting

I came across my first instance of an insurance company requiring a patient to split tablets about a month ago. One of our regulars has recently switched to a new doctor, and the doctor is adjusting doses on his various therapies. In any case, the doc prescribed citalopram 20mg qd #30, but the insurer (UnitedHealth for the win!) would only pay for citalopram 40 ½ tab qd #15.

What the hell is with that? You’re going to make a guy with acid reflux, anxiety, depression, hypertension, hyperlipidemia, BPH, and T2DM split his fricken tablets?? Are you kidding me? This guy can barely remember all the medical conditions he has, nevermind what pills he takes at what time for which condition. (There’s about 15 meds in all that he takes on a daily basis.)

I felt awful. I called UnitedHealth to no avail. I tried doing a prior auth — yeah, I do that sometimes when insurance companies let their little algorithms run wild without human supervision — nothing.

So now this guy has to remember to split his tablets as well when he’s lucky he can get out of bed and tie his shoes in the morning. What assholes. This guy is NOT going to remember to do this right, and there’s nothing I can do about it.

What about the money lost through patient non-compliance? I suppose that’s not so easily measured when compared to a guaranteed savings of ~$5 per fill by instituting mandatory tablet splitting, so fuck it. We’ll deal with the excessive cost of less-than-optimal therapeutic outcomes later.

(I’m conflicted about the idea behind splitting tablets for people since it destroys the tablet’s integrity, and can confuse people when they open a bottle and see a bunch of little half tabs staring back at them. I would have asked anyway, but I was so pissed off at UnitedHealth when I got off the phone that it didn’t occur to me.)

[tags]Medicine, pharmacy, HMOs, UnitedHealth, tablet splitting[/tags]

6 thoughts on “Mandatory tablet splitting

  1. What a crazy situation. It also assumes the active ingredient is uniformly spread through the tablet, which it might not be.

    Is the guy splitting his own tablets, or has he a carer? I’m in my 30s and find it hard to split a tablet without crushing it-Normally using a razor-blade.

    Is there any long half-life drugs that he can take one tablet of, every other day. Still not ideal, but at least the tablet stays whole.(Assuming he remember to take it)

    Some drugs in the UK are the same price for different strengths. I haven’t seen tablet-splitting yet, but it probably will eventually happen!

  2. did they already have a supply of the 40mg that the ins wanted finished? I’m a pharma but i do PAs for medicade, we’re all pharamcists here and my state has a mandatory prospective dur which is where we come in, the only time this would happen here is if they got the 40’s two days ago and then got an rx for the 20’s today.

  3. Yes, well, that’s UnitedHealth for you. Scum of the earth. When I was looking into buying health insurance privately, I refused to even consider doing business with them simply because I don’t like their business practices.

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