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By Vicki Lankarge insure.com

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"Kaiser does not have a mandatory pill-splitting policy. No way. No how."

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Six California Kaiser Permanente patients and one doctor formerly under contract with the nation's largest nonprofit HMO are suing Kaiser for allegedly forcing its members to split pills.

The plaintiffs in the class action lawsuit, filed in California Superior Court in Oakland on Dec. 6, 2000, are represented by the Trial Lawyers for Public Justice (TLPJ), a national nonprofit public interest law firm with offices in Washington, D.C., and Oakland, Calif.

At the core of the lawsuit is the charge that Kaiser's mandatory pill-splitting policy endangers patients' health solely to enhance the HMO's profits. They say Kaiser forces patients pres­crib­ed smaller-dose pills to accept and cut in half the larger-dose pills. TLPJ attorneys allege that Kaiser adopted its pill-splitting policy because it allows the HMO to profit since smaller-dose versions of most prescription pills cost Kaiser almost as much as larger-dose versions of the same pill. 

The lawsuit charges Kaiser with violating California Business and Professions Code Section 17200, which bars unfair business practices; Section 17500, which bars false adver­tis­ing; and the state's Consumer Legal Remedies Act.

Kaiser spokesperson Beverly Hayon calls the charges "bogus" and says that pill splitting is purely voluntary and only encouraged for a handful of drugs — and then only for those patients who would not be adversely affected by an imprecise dose. "Kaiser does not have a mandatory pill-splitting policy," says Hayon. "No way. No how."  

Patients say reality is different than Kaiser's public policy  

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"When I tried to split the pills, I usual­ly ended up launching them across the room."

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However, TLPJ attorneys contend in their lawsuit that Kaiser patients experience a very different reality than what is represented in Kaiser's public policy. "Patients are not given a choice about whether they want to split their medi­ca­tions," the lawsuit states. "They are simply provided the double-dose medi­ca­tions and a pill-splitter, often without direction or instruction."

Mandatory pill splitting has been condemned by the American Medical Association (AMA), the American Society of Consultant Pharmacists (ASCP), and the American Pharmaceutical Association (APhA) due to the health risks involved. These include the chance that patients will divide the pills unevenly and wind up taking incorrect doses or, because some suffer from cognitive impairments, they may forget which pills they must split.

Says plaintiff Audrey Timmis, a 72-year-old woman who suffers from emphysema: "When I tried to split the pills — which were slightly smaller than an aspirin — I usual­ly ended up launching them across the room like tiddly-winks or crushing them into powder between my fingers."

Timmis says she tried to get her doctor to change her prescription to a dosage that would not require splitting, but to no avail. "It was clear to me then that Kaiser didn't care about me or my health," she says. "All they care about was saving money."  

Cost savings by splitting pills Hayon says she believes the public's frustration over the high cost of prescription drugs is re­spon­si­ble for an increase in such litigation. "Pill splitting is one of the few ways, where warranted, that insurers — and therefore their members — can save money on prescription medicine," she says. "But when an insurer tries to cut costs, the public, the media, and the trial lawyers make it look like a bad thing. But when a patient splits pills and saves money, there's no nega­tive connotation."

But TLPJ attorneys say there is a big difference between a patient voluntarily splitting pills to save money and an insurer forcing a patient to do so in order to enhance profits. "Kaiser promises in its advertisements that patients come first and that cost is the last consideration, but its pill-splitting policy puts patients last and money first," says TLPJ lead co-counsel Sharon J. Arkin. "It's hard to imagine a more blatant consumer fraud."

Insurers can conceivably save a sizable amount of money by pill splitting, according to the attorneys. For example, 50-milligram tablets of Zoloft, an antidepressant, cost approximately $227 per 100, so it would ordinarily cost an insurer $454 to provide a patient pres­crib­ed 50 milligrams per day with 200 daily doses. But 100-milligram tablets cost about $233 per 100, so the insurer can increase its profits by $221 on a single prescription by forcing the patient to accept and split the 100-milligram tablets to obtain 50 milligrams per day.

Kaiser "does not share the savings with the patients," according to a TLPJ press release, "or warn them of the health risks involved."

Kaiser is battling a similar class action lawsuit filed in March 1999 by the Foundation for Taxpayer and Consumer Rights, which alleges that Kaiser spent $60 million a year on ads that fraudulently claimed that its doctors aren't influenced by the HMO's financial concerns. The foundation alleges that, contrary to the advertisements, there is fiscal interference with medical decision-making and that Kaiser withheld up to 30 percent of doctors' salaries and tied bonus pay and other com­pen­sa­tion to profit goals.

According to Foundation spokesperson Jamie Court, that lawsuit is now in the discovery phase.