According to a report by the Kaiser Family Foundation, prescription drug spending has been one of the fastest growing components of national health care expenditures, increasing at double-digit rates over the past decade.

To combat these skyrocketing costs, benefit professionals and self-funded group plans are continually searching for ways to maximize savings for both the plan and its members. It is becoming even more of a priority now as a result of the down economy.

An increasingly popular program offered by pharmacy benefit managers and health plans is tablet splitting, which can be effective in managing costs and increasing cost-effective prescription benefit usage.

The concept of tablet splitting is very simple. It allows members to get medications at a higher dosage and split the tablets in half, saving both plan dollars and member out-of-pocket expenses.

There are several critical components to implementing a successful program. The employer, PBM, prescribing physician and patient each must do their part for tablet splitting to be effective.

Plan design

Tablet splitting is easy to implement with percentage copay plans, as the savings are a built-in feature. With certain plan designs, however, special programming by the PBM may be needed to adjudicate tablet splitting claims with a reduced copay.

Qualifying medications

Not all medications are safe to split, so a defined list of medications appropriate for splitting is a very important part of any tablet splitting program. The list should be developed by a PBM's pharmacy and therapeutics committee, which consists of a team of expert pharmacists, physicians and medical professionals. They make the selections according to specific criteria, which may include medications that are:

•  Directed for a once-daily dosage schedule.

•  Not dependent on a limited therapeutic range.

•  Flat-priced or nearly flat-priced to present an opportunity for savings.

•  Not delivered by an extended release system.

•  Not enteric coated or of a special formulation that would be damaged.

Ensuring proper dosages

For tablet splitting, the dosing indication on the prescription will likely need to reflect "take one-half tablet daily." This helps physicians make sure patients have a clear and concise understanding of how to correctly take their medications in compliance with the new dosage indication.

The new dosage indication may also be necessary for the pharmacy and PBM to process the prescription claim appropriately for members to save money with tablet splitting. This is especially true for plans with flat-dollar copayments.

The importance of employer involvement Communication is another key to a successful tablet splitting program. Plan sponsors should actively promote the program among members to increase awareness and participation. They can partner with their PBM to help members gain a better understanding of tablet splitting.

Quality PBMs offer standard communications pieces, such as brochures, payroll stuffers, electronic newsletters, presentations, Web sites, Webcasts and member portals, ready for use by plan sponsors.

The patient's role

Patients also need to be proactive. When a decision is made to split tablets, it is their responsibility to initiate the tablet splitting process by seeking a new prescription for the revised dosage from his or her doctor.

Tablet splitting in action

Innoviant, a prescription solutions company, offers a tablet splitting program called Half Tab Rx. The following snapshot demonstrates current utilization and projected savings from the 12 medications approved for the Half Tab Rx program. In this example, the plan has a flat-dollar copayment structure and approximately 3,400 members.

Without Half Tab Rx, the plan and its members cumulatively spend nearly $160,000 annually in prescription costs - approximately $120,000 by the plan sponsor and $40,000 by members.

With Half Tab Rx, the same plan and its members may save more than $20,000 in annual prescription costs based on 25% of members using Half Tab Rx. This equals an approximate savings of $15,000 for the plan sponsor and $5,000 for members.

Actual savings will vary based on individual plan design and member compliance, but tablet splitting programs already are creating savings for plans and their members.

As benefit professionals and self-funded plan groups partner with PBMs to implement tablet splitting programs, everyone has a role in making sure it succeeds. From the plan sponsors and PBMs to the physicians and members themselves, everyone plays a critical part in making these programs successful and ensuring the path to true bottom line savings.

Jon Warren is the director of PBM product management at UMR.