medicine, drop size, and vampire blood

[cellio]

A recent mailing from my employer's department of reducing health-insurance costs (that's probably not their real name) offered some advice that seemed questionable to me. They suggested splitting pills -- not, they hastened to point out, that we should take half the dosage we need, but rather, we should get pills that are twice as strong as they need to be and then split them. They suggested that a stronger drug doesn't necessarily cost any (or much) more to fill, so you can fill your prescription half as often, saving you half the copay and them a lot on the balance. (Aside: what bright person decided that your cost, if insured, should be per month rather than per some volume? If I take a medicine twice as often as you do, why shouldn't I pay twice as much for it?)

I wonder how the pill-splitting scheme could actually be implemented legally and what doctor or pharmacist would go along with it. I find it hard to believe that a large company would advise its employees to commit insurance fraud (in a manner that's traceable), so there must be a way to do it, but I'm puzzled. (The company self-insures; maybe that's why it's ok?)

I was telling this to Dani last night, and commented that even if it's kosher I can't benefit from it for my prescriptions -- the medicine I take for glaucoma is in the form of eyedrops, and I don't know how to get double-sized drops. (Nor am I going to ask my ophthamologist to write a bogus prescription.) This, combined with some recent TV viewing, led us to wonder how big a drop is, anyway. We didn't have an internet connection to hand; Dani tried to work it out theoretically while I tried to work it out empirically. (Things often fall out that way with us.) A medicine that I take once a day (two drops) comes in a 2.5ml bottle and lasts about a month (maybe a little more). Viscosity matters, of course; this stuff is closer to water than to syrup. So I posited about 25 drops/ml for my medicine. (Google later suggested 20 drops/ml of water as an approximation.)

And that's when we turned our attention to the amount by which a character in the True Blood episode we'd just watched overdosed. The character had a quarter-ounce vial of an illegal substance (vampire blood) that he was supposed to take one drop of at a time. Wikipedia tells me that the viscosity of normal blood is about three times that of water. It has no data on vampire blood. Assuming (and I don't know if that's valid) that drop size is directly correlated with viscosity, this suggests that the character overdosed by a factor of approximately 46. Ouch. :-) (Yes, it did hurt.)

Ok, fine -- what have you done with your science education lately? :-)

Comments

[ichur72.livejournal.com]

There's another reason why it might be a bad idea. If I understand correctly, some pills are formulated in such a way that you really ought to take them whole -- e.g., the drug is not released on the desired schedule if you circumvent the process of letting the coating dissolve and then moving on to the innards of the pill.

[sue-n-julia.livejournal.com]

I was going to mention this myself. I take pain meds that splitting them actually could cause overdoses as too much hits at one time. And if someone is using a pain patch, that's even worse.

I think a message to the Pennsylvania Insurance Commission might actually be in order. Insurance companies should not be suggesting dangerous strategies to reduce their costs.

S

[cellio]

Oh, good point. Even though I actually had that knowledge available (discussions with my vet about mixing Erik's meds into his food), I hadn't thought of that.

[ichur72.livejournal.com]

It was one of the first things that came to mind as I'm on an extended-release medication that doesn't work as intended if it doesn't dissolve from the outside in.

All in all, it seems safe to say that your employer's department of reducing health-insurance costs could stand to develop some better ideas. I know that saving money almost always involves making hard choices, but the strategy they suggested just sounds hinky.