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

[paquerette.livejournal.com]

Is it sort of like with soda pop? You pay just about the same for a 20 oz soda as you do for a 2L. The cost of teh actual ingredients is negligible; it's the cost of creating the product and bottling it (or turning it into tablets) that you're paying for.

I'm glad to hear from a pro on this, as I had always thought that the "getting larger pills and splitting them" was inherently illegal, something about meds only being able to be used as labeled or something like that. I don't know why.

[baron-steffan.livejournal.com]

I'm not privy to the arcane mysteries behind how Big Pharma determines their ultimate wholesale prices, but clearly it isn't directly proportional to how much actual active drug is in the bottle. This is a classic case of political spin-doctoring: to me, it looks like they're sticking it to me because they're not giving me a discount for buying a tenth as much drug: they're charging me the same price for 100 mg (100 x 1 mg) as they are for 1,000 mg (100 x 10mg). But they will say, no, no, what they're doing is that they're *not* charging me $1,000 for 1,000 mg...aren't they just wonderfully generous and kind-hearted and altruistic? So how do you interpret it? Clearly there's a lot going on in this calculation, and it involves research and regulatory costs, advertising, projected life of their market share before Barr Labs comes out with the generic and all their efforts go "poof" overnight in a puff of mist...IOW, way more than the bare cost of manufacturing 1,000 mg of mickeymycin.

As for the splitting issue, what would be fraudulent is if I gave you two months of drug and billed it as one month, or claimed you were taking two a day when the Rx is for 1 a day. But I'm not doing that. It's all on the up and up.