Onetouch monopoly?

I have 2 different prescription plans. Last year one of them declared they will only cover onetouch strips. starting next year (tomorrow) my secondary coverage will only cover onetouch as well. Is my experience unique or is this widespread? If they are strong-arming other manufacturers out of the insurance market and forcing us to buy their product without competition, it is likely illegal here in the USA. Or maybe that’s just cooincidence that both my policies happened to go that route.

Let it be noted that I do not like onetouch or their business practices, and consider their product subpar.

There's big money in over-priced test strips. I think that corporations routinely manipulate markets to their advantage. All while they pay lip-service to the "free market." I was forced to switch to Walgreens and a 4-week supply plan because the 90-day Medicare plans would not supply my preferred brand, Accu-Chek Aviva. Both of the 90-day vendors excluded Accu-Chek for 2015 and told me I needed a new meter. I told them, "I don't need a new meter and you're fired." I took my 14x/day usage to Walgreens.

These suppliers are all about the money. There's no compassion in their plan. They don't know how hard we work to live a normal life and how many factors we juggle every day. And they don't care. They don't realize that vigilantly monitoring our BGs is a public good, as in preventing a car accident with a car they might be driving.

They get away with it because, they don't simply stop covering the other brands, they just move them into an, even higher priced copay, non-preferred tier.

It isn't so much One Touch as it is the bargaining process (bid process) that health plans put out there. The company - in this case testing supplies - that give the best (i.e. lowest) price gets the gig. The same thing happens with insulin(s), pumps etc.

I received a similar letter from my PBM. Now, I will have to go through a bunch of hoops and additional precious $$$ (not to mention the value of my time and the value of my endo's time), to arrive at a solution that will still end up costing me more.

For me, here's the real rub - my test strips and meter are tied to my pump. The bolus calculator and remote control features that I enjoy are useless with any other meter.

I can appreciate trying to control costs to make dollars go farther, but this is just icing on the cake for my PBM.

Oh, and FWIW, I just received the annual report for my company's self-funded health plan. Guess what, in spite of all the grumbling about how much health plans cost the parent company, ours turns a significant profit (and has always done so)!

That’s not always the case. Neither of my plans will now cover anything but onetouch, at all. It’s onetouch or nothing. They offer no other alternatives at any price other than pay for the entire retail cost out of pocket.

I actually was relieved to see fine print on my recent letter saying something to the effect of “members using medical equipment which are only compatible with freestyle testing strips may be eligible for an exception” I can only assume they are referring to omnipod customers

Because your meter is tied to your pump (I have an animas but don't like the remote and prefer to enter my info manually - I caN EDIT BASED ON MY PLANS ETC) aNYWAY, YOU CAN HAVE YOUR eNDO WRITE A LETTER OF MEDCIAL NECESSITY CITING THE CONNECTION BETWEEN PUMP AND METER. tHAT SHOULOD HELP. yOU MAY HAVE A HIGHER CO-=PAY BUT YOU WON'T BE PAYING RETAIL. (OOPS SORRY - HIT CAPS KEY)

And I know how you feel about seeing that annual report. Where I live, a health plan bought the naming rights of the sports arena - hmmmmph instead of paying claims. Actually there is the sports arena and the soccer venue named for health plans.

I’m really not opposed to the preferred / non preferred rates concept— but when they offer no choice at all I find it quite irritating. It’s not really their job to cater to my preferences, but if I’m willing to pay the difference, it seems quite unreasonable for them to deny that opportunity.

Well that sucks. At least mine is grasously going to allow me to pay double for the Contour Next strips.

Overall, since I find the accuracy of most meters is pretty much the same, I'm just glad to have strip coverage.

Generally what you have experienced is the wave of the future. As insurers look for ways at the margins to reduce costs or increase profit, they increasingly enter into exclusive test strip contracts. This is not limited to test strips. The medical market is devolving into a limited market for competition. Insurers prefer the up front cost savings as opposed to the more harder task of negotiating multiple contracts with many vendors. The vendor has incentive to offer deep discounts betting on eliminating other manufacturers.

This leads to strip manufacturers signing exclusive arrangements with pump manufacturers in order to force insurance companies to support their strip company. It will also lead to less manufacturers int he long run.
margin

This just points out the incredible margin in strip sales. A margin that will get bigger if the strip manufactures succeed in driving out competitors. Incidentally it will also drive out innovation in the long run. One touch is an excellent case in point. They often supply the lowest cost strips largely because they have not innovated to provide better testing. look at it this way, if the current strips are good enough then why innovate to provide tighter error margins? Really no need. It is easier to drive out competitors by lowering margins slightly.

the bottom line to support the effort to tighten strip accuracy so that any such deals are at least on a new and better footing. Currently even if a strip that has an margin of error of 5% could be produced, it would be wiped out by the cost of strips that have a 20% margin of error.

We have t gauge what is best, temporally lower costs for strips or better test strips. It is a devils choice. .........................rick

Yes, I do know about the "letter of medical necessity", which IMO points out just another bit of absurdity with our health "system". FWIW, I can and do edit based on my plans, but I am able to do so within the meter/pump functions.

(Begin rant): So now I have to engage with my endo and have this document written and sent, then I have to wait to see what the outcome is. This translates into extra time, effort, anxiety and expense. Does the doctor's practice get reimbursed for this? No! Who pays for the extra staff @ the PBM to evaluate the letter, communicate their decision, etc? If I have to appeal a second time, then there's essentially a repeat of all of the above. Then, assuming that my PBM finally relents, then no doubt the co-pay will still be higher.

Now couple this with the idea that I have a prescription for these scripts and to me, that is a letter of medical necessity all by itself, isn't it? (End rant!)

Rick, I understand the high margins and the wave of the future. Let's also keep in mind the wave of the future is for more accurate CGMs that will virtually eliminate the need for test strips altogether. This is another reason Roche is desperately trying to sell their meter business, but getting no takers. It's also why Roche is looking into developing their own CGM.

I've had sort of the opposite experience, I liked One Touch, and used them for years but Blue Cross nudged me over to Bayer about a year ago. There are pros, with the brightly lit meter, and I guess it's less hassle for the doc to get the strips as there's not a "letter of medical necessity" involved however the case utterly sucks so I've taken to jamming the Bayer meter into the One Touch Ultra mini case. It was *very* uncomfortable however it seems the Bayer reads a big higher with the "takeaway" that my A1C has come down a small amount since using the Bayer meter.

I also saw a blurb in my FB feed, which I can't find now as the new year's posts have wiped out the newsier threads, that meter manufacturers have responded to the clamor for meter accuracy, and tighter FDA standards, that they are going to have to make bigger and more expensive meters in order to do so. This is a bit disturbing to me as the portability of meters is a big part of my game plan....

The problem I have with insurance companies choosing a single meter/strip provider is that these decisions are made simply on cost, eliminate competition and restrict consumer choice. We have all heard horror stories of truly lousy meters supported by Medicare and the same thing happens with this inherent corruption with insurance companies as payors. What really is missing from this process is any factor which involves meter performance and specifically how effective it is for each individual patient. And unfortunately not all meters are the same for each person as there are various things which interfere with results.

It seems to me that we should be able to claim medical necessity by arguing that we need meters that are more accurate instead of the negotiated meter. I'm sure you could argue that if you have an interfering factor (like hematocrit) that you should be able to get a meter which doesn't give erroneous readings.

ps. I have the One Touch Verio IQ which I find performs quite well, has been evaluated as one of the highest performing meters and can handle my high hematocrit.

^^This.

The conspiracy theories are simply mistaken. This *is* the free market at work. And it helps keep insurance premiums down.

I don't know what people think the alternative is. Government force insurance companies to cover whatever supplies the patient wants, at whatever price the manufacturer charges?

What do you think will happen to the cost of health care then?

The truth of the matter is we, diabetics, cost much more than we pay into "the system". When asking someone else to pay for something for you they're going to, rightly, set the rules, and also, rightly, seek to minimize their cost.

Why this is so often cast as nefarious is hard for me to understand.

Government force insurance companies to cover whatever supplies the patient wants
Not what the patient wants, but what the government wants, and it is already happening! The government tells insurance companies what they must provide, how much they can charge, and in some cases that they are not allowed to charge anything at all.

The government needs to get out of OUR business and let the real free market reign. Exclusive arrangements would never work absent government help, err, interference.

Having lived abroad, where there is single payer- often govt health coverage, I have to disagree. Yes, my taxes were higher, but the additional taxes were less than insurance premiums, elder care for my aged parents as well as child care etc. I paid premiums for close to 20 years before my Dx with type 1. Once the health plan got the first bill for my Dx and initial treatment, they notified me that I was no longer a member of the health plan. One of the things that the ACA changed was that health plans cover testing supplies - recognizing that test supplies make it possible for us to avoid the far more expensive (and devastating) complications and made it possible for people to have access to health care before they were so sick that they required hospital admittance and only received a pittance towards their incurred costs. Healthcare shouldn't be a privilege for only those with lots of money and in my opinion health plans shouldn't be for-profit entities. I resent the first part of my monthly premium going to stockholders instead of paying claims. But then, that's just my opinion.

And I don't think it is a matter of what thee patient wants, as much as it should be what the patient needs. I want to be able to test 10-15x a day and that means I won't cost a health plan (or medicare when that time comes) for dialysis, assisted living care etc.