I'm weary of the 90-day Rx supply battle, one partial solution

Early days

I’ve used blood glucose test strips since I was diagnosed in 1984. At first these consisted of BG Chemstrips, strips not read by a meter but instead compared to a color panel printed on the side of every tube of strips. It was an exercise in placing the blood, wiping after a specified interval, and comparing the color of the two pads after another time interval elapsed. You could make educated guesses along the lines of, “that’s somewhere between 120 mg/dL (6.7 mmol/L) and 140 mg/dL (7.8 mmol/L).”

My therapy consisted of syringes and vials of NPH insulin, before adding Regular insulin for meals. I always tested a fair amount; back then I probably averaged about 6-8 times per day.

When digital BG meters were a new thing

When digital meters showed up in the early ‘90’s, I switched to that system and really like having an exact number, even though I knew the system wasn’t as accurate as the digital number implied.

Over the years, before my adoption of a CGM, I gradually increased my testing and eventually kept up a habit of about 10-15 times per day. I was a bicycle enthusiast for many of those years and found that testing frequently helped keep me out of hypoglycemia trouble.

CGM added to the mix

When I started on my Dexcom 7+ CGM in 2009, I kept up with my frequent testing because the recommendation was not to rely on the CGM for treatment decisions, so I just continued my aggressive testing frequency. I think many in my cohort, however, backed off of their fingerstick tests and started to rely more on the CGM much sooner than I did. I had became so habituated to testing that I didn’t consider it much of a burden. I’m kind of weird that way.

When the FDA decided in December 2016 that one could rely on the Dexcom CGM to make treatment decisions, I decided it was time to start feathering back on my strip use! Over the course of the last year I’ve dropped my fingerstick ritual down to 2-3 times per day.

I use a hybrid do-it-yourself artificial pancreas system, Loop. As long I can keep my Dexcom G4+Share CGM happy, Loop can make good dosing decisions.

Subscribe and lose the aggravation

Now I’m down to my last 500 strips or so and I need to decide how to resupply. I had been using a Medicare supplement insurance plan that I earned through my former employer. That plan meant that I could get a 90-day supply of test strips for a single co-pay. Over the years the co-pay has risen a significant amount, currently it’s at $92 for a 90-day supply. But I made that a bargain when I had my doctor write scrips for testing 14 times per day or a 90-day total of 1250 strips.

I’ve been using the Roche Accu-Chek Aviva system and strips for many years and they’ve been rated well for accuracy and precision by various testing schemes.

I’m tired of the whole insurance game and I’m starting to see blood glucose test strip subscription plans offered. What’s really appealing to me is that I don’t have to manage the order every 90-days. Over the years it seems like I was in some kind of unfriendly tug-of-war trying to manage the doctor, the doctor’s office, the supplier, and whatever delivery method they chose. I hated that activity. After working my way through all their phone menus, I felt like a rat in the maze. I was often in a sour mood when this arose every 90-days. And, of course, I did and still do have to do this for CGM sensors, transmitters, insulin pump infusion sets, and other supplies.

Diathrive

I ran across one test strip supply subscription service today that really seems seductive. It’s called Diathrive. You can order a 90-day supply of strips in 100 strip increments anywhere from 100 to 600 strips. Six hundred strips cost $90. The unit cost of the strips range from $0.24 to $0.15 per strip, depending on quantity. It seems like a no-nonsense kind of company. There are no contracts and you may terminate or pause your deliveries at any time. They maintain a 100% money-back guarantee policy. They bundle your first order with a meter, finger-poker, and lancets at no extra charge.

So, I’m thinking, I pay a $92 mail-order Rx copay. I can get 600 test strips from Diathrive for $90, save $2 and lose all that irritation of dealing with the doctor, medical assistant, ordering staff at the pharmacy, and the delivery snafus.

Good move?

The strips they sell are ones I’ve never heard of but they claim they not only meet the +/- 20% FDA-required accuracy but actually enjoy +/- 15% accuracy. The meter and test strips are the On Call Express brand.

Diathrive is not the only test strip subscription service on the market. Livongo and One Drop also provide a similar service. Check out this Beyond Type 1 article that surveys the subscription market.

I’m tired of fighting for my D-supplies and this service seems like a way to partly ease the pain and appears to be a breath of fresh air. What are your thoughts?

Note: I have no relationship with Diathrive except as a potential customer.

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What is loop exactly? If you’re going to pay the same why not try it? My worry would be they may raise the price at some point and maybe they’re not as accurate but I guess you can switch back. But then you may have to fight again to get what you need.

Not much of a risk. I do need to do some due-diligence on the accuracy aspect, however.

Maybe they can give you a sample first?

Loop is a hybrid artificial pancreas system comprised of an Apple iPhone, Dexcom CGM, a 2005-era Medtronic pump, and a small radio bridge that fits in a Tic-Tac box. It varies the insulin pump basal rate depending on where it predicts the blood glucose line is trending. It makes this decision to add, subtract, or stand pat on the background pump basal rate every five minutes. It does a better job than I ever did before I started using it last November.

The comparison does not seem to compare apples with apples, though: you get 1250 strips for $92, but 600 for $90. Can you live with 600 strips for 3 months? We get 1,200 per 3 months and use pretty much every single one of them.

Why can’t your doctor give you a prescription that is good for a year’s worth of strips? That’s what we have: a prescription for 1200 strips for 90 days, good for 1 year and 3 refills. We only have to ask for a new prescription every year.

I actually like the OneDrop model (all you can eat subscription model for $480 per year plus $100 meter) – but there are quite a few stories around the web of significant delivery failures with OneDrop, the most mature of them (I would give the links but I imagine you’ll take them off) so I would be leery of recommending them to anyone yet. An unproven provider like Diathrive may be worse in terms of reliability.

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You’re right, it’s not a fair comparison. But I no longer need 1250 strips for 90 days. I’m thinking 600 may even last longer than 90 days. My new lower quantity requirements are making considering a subscription model feasible.

I’ve actually been getting one year prescriptions for 90-day supplies with three renewals for many years now. It still required more care and feeding than I thought was necessary. How many ways can a supply house screw up a supply order? I think I’ve seen every permutation.

You should feel free to post informative links with sufficient context.

Diathrive has been in business for two years. They should have a material track record.

I’ve been using One Drop since January. I’ve had a couple times when the app seemed to order new strips, but the order never processed; however, the last of a confirmation email within a day, max, makes that failure clear. Once I’ve gotten confirmation of an order, I’ve not had any shipping/delivery issues of One Drop strips – and I very much appreciate the stress-free approach, that if I need strips, they’re just a few clicks away (usually).

Of course, we still have to participate in the Insurance dance for other supplies (CGM, pump, insulin), but it is nice to take one needed supply out of the game. I’m hoping Bigfoot’s eventual product and possible subscription model helps make other aspects easier, but that’s still a wait-and-see.

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Webpage by the manufacturer describing the meter:
https://www.aconlabs.com/us/glucose/on-call/express-bgms/

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Wouldn’t it be great to just have all the supplies you need, when you need them, at a fair price, and without the phone maze and hold audio? I think the pharmacy benefit managers are a big part of the problem.

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Sounds interesting. I’d be worried to let it change my basal though without me knowing etc. because dexcom is often wrong for me. Is this a system you buy somewhere? I’m a bit confused- can it be used with any pump and cgm? The thing I may need sometimes is to turn off or slow down basal when I’m sleeping. There is one pump that does that- I’ve forgotten which one now.

Loop is a do-it-yourself hybrid system that relies on the CGM being reasonably accurate. It is designed to fail safely and fall back to the programmed pump basal rates. There are online communities on Facebook that provide support and instructions about this project. Here’s a link to some Loop documentation if you’re curious.

These hybrid systems are not for everyone.

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IF i could gather the supplies, I’d try it! But, as it is… waiting…

In terms of Loop as I read it, the biggest logistical problem is obtaining a compatible pump. The most recently manufactured pump which is compatible with the Loop technology is now 5 years old. Nothing newer is compatible.

Although as we do not run the Loop, I certainly could have misunderstood.

I crave system simplicity in diabetes care. For that, you can’t beat this - Test strips. Over the counter. No Rx. Cheapest in town.

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I’ve read lots of good comments about the Walmart strips. For a hundred strips at $17.88 that brings the unit cost to $0.18 per strip. The unit cost when buying 600 Diathrive strips is only $0.15, not a big difference but still cheaper.

I plan to compare the Diathrive strips to my doctor’s lab. If I’m not happy with that comparison, I’ll try the Relion brand from Walmart.

The last time I did this with my Accu-Chek Aviva system I did the fingersticks right before a lab blood draw and measured 80, 85, and 86 mg/dL or an 83.7 average. The lab came back with an 82, a very acceptable comparison. This is the only way I know to confirm the accuracy of our home blood glucose fingerstick systems.

Thanks Terry, I’m going to check this out for sure.

These are my back up meter and test strips. They’re good.

My guess is that once I get CGM coverage through Medicare that I will have to pay for strips beyond the 2 per day provided as part of the Dexcom package. I don’t think that anyone knows whether our doctors will be able to justify more strips. As someone who doses off my Dexcom almost all of the time, I still test about 4-6 times per day and sometimes more.

I would probably use the Relion strips from Walmart because the price is great and they are highly rated. As much as I like my Freestyle strips, I would never pay retail for them.

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Accu-Chek introduced a new meter, the Accu-Chek Glide. They also introduced a low cost program for those who self-pay. Accu-Chek’s SimplePay program prices the Glide strips at $19 for the first fifty (50) and $10 for each additional fifty provided that they are all purchased at the same time. The SimplePay program does require patients to obtain prescriptions from their respective physicians for both the meter and an appropriate quantity of strips (under the SimplePay program, the meter is free with the Rx and includes their FastClix lancing device). I had my doctor write the Rx for 300 strips (90-days supply) with three refills. The cost for the 300 strips was $69 ($19 for the first 50 and $10 for each additional 50). That’s equivalent to approximately 20 cents per strip (after the initial fifty – purchased at the same time).

Accu-Chek claims the Glide is their most accurate meter to date and my own test results seem to support that claim; well, sort of. Glide test results seem to run 5 to 10 points higher than my FreeStyle Insulinx but it appears to be relatively consistent. And consistency makes it safe to use for gauging my insulin injection. It bears repeating that the SimplePay program is restricted to users who self-pay and may not be submitted to any insurance carrier or government agency such as Medicare, Medicaid, or VA. The Glide strips also have a very unique type of capillary action that allows you to apply your blood sample anywhere on the end of the strip and it gets sucked up and distributed across the entire width (its amazing to see the first time you try it). The Glide strips also come with unique packaging that is virtually spill-proof. Here’s a link for Accu-Chek’s SimplePay program that includes more information on the Glide meter and strips:
https://sites.accu-chek.com/microsites/guide/simplepay.html

I test more frequently than what insurance covers so the Accu-Chek SimplePay program is a real blessing and the price is as low as many no-name, less-accurate strips.

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