Initial Results of the Use of Prescription Order Change Forms to Achieve Dose Form Optimization (Consolidation and Tablet Splitting) of SSRI Antidepressants in a State Medicaid Program
Ann M. Hamer, Daniel M. Hartung, Dean G. Haxby, Kathy L. Ketchum, David A. Pollack
Journal of Managed Care Pharmacy
he clinical impact from many drug cost control policies remains largely unknown, and some policies may have adverse health consequences. 1 Dose optimization is one strategy to reduce prescription drug costs while maintaining nearly identical therapy. Flat-pricing of prescription drugs (i.e., all strengths priced the same) presents an opportunity to save up to 50% of the original prescription cost by using half of a higher-strength tablet (tablet splitting) or by using 1 higher-strength tablet
... stead of 2 lower-strength tablets (dose consolidation). The selective serotonin reuptake inhibitor (SSRI) antidepressants are ideal drugs for dose optimization. SSRIs have relatively flat pricing, are manufactured in forms that can be easily split, have a long half-life (with the effect that they are generally taken once daily), and their clinical actions depend on long-term alterations of receptors and neurotransmitter production. Minor variations in dose from the split SSRI tablets are not likely to have significant clinical consequences. 2,3 In addition, SSRIs have a large therapeutic index, so if the dose is inadvertently doubled, the consequences are not typically toxic. 4 Still, not all drugs and not all patients are candidates for dose optimization. For tablet splitting, patients should be physically and cognitively capable of cutting tablets. The potential cost avoidance of dose optimization programs can be significant. 2,5-7 According to Cohen and Cohen, U.S. taxpayers could have avoided in excess of $1.7 billion dollars in 2000 if all new antidepressant medication prescriptions that ABSTRACT BACKGROUND: One method to reduce drug costs is to promote dose form optimization strategies that take advantage of the flat pricing of some drugs, i.e., the same or nearly the same price for a 100 mg tablet and a 50 mg tablet of the same drug. Dose form optimization includes tablet splitting; taking half of a higher-strength tablet; and dose form consolidation, using 1 higher-strength tablet instead of 2 lower-strength tablets. Dose form optimization can reduce the direct cost of therapy by up to 50% while continuing the same daily dose of the same drug molecule. OBJECTIVE: To determine if voluntary prescription change forms for antidepressant drugs could induce dosing changes and reduce the cost of antidepressant therapy in a Medicaid population. CONCLUSIONS: Voluntary prescription change forms appear to be an effective and well-accepted tool for obtaining dose form optimization through dose form consolidation and tablet splitting, resulting in reduction in the direct costs of SSRI antidepressant drug therapy with minimal additional program administration costs.