Relion test strips: An example of how WE, the healthcare consumer, are the problem

Diabetes Advocacy Self Advocacy
1

Warning: This is a bit of a soapbox, a somewhat volatile issue, and there are political elements to it. If you aren't interested in the mano-a-mano that is inevitable with discussions like this, you're probably better off moving on.

I saw the ad again this morning by Walmart for their Relion BG meter and strips. $9 for 50 strips.

Freestyle strips are $77/50 at Walmart. 11x the Relion strips.

If Relion strips are as accurate and reliable as any of the others, what business do we, the insurance customers, have demanding anything more expensive than Relion?

That right there is the main reason for outrageous health care costs -- we, the consumers, do not make much of an effort at all to "shop". Indeed, when we hear that an insurer is going to drop covering a particular test strip and system, many PWDs go postal.

This is the way it is when someone else is paying for your stuff. Yeah, I'd be quite satisfied with hamburger 'cause it's good, tasty, reasonably nutritious, and that's what I can afford, but if someone else is willing to buy me Filet Mignon if I scream loud enough, why not?

I'm going to check out the Relion strips, both in terms of online research, and giving them a go myself and checking side-by-side with my Freestyle strips.

If there is no meaningful difference, I can't in good conscience demand that you and everyone else subsidize my "need" for something I don't really need, but just want. If all goes well, I plan to have my Endo change my prescription to Relion.

This same selfishness plays out over and over and over in health care. A great deal is wasted that wouldn't be if people had to make actual spending priority decisions. I'm not talking about choosing whether to eat or pay for one's life-saving drugs: I'm talking about things like this test strip issue.

If I had to pay OOP for test strips, there's no question I'd be using Relion, assuming they're as good enough as the expensive ones. Only having to pay my $35 copay to get 150 Freestyle strips, well, I've been doing that for years and years, letting all of you (and everyone else) cover the $196 each month, for a whopping $2,352/yr of complete $$ waste.

Money that could have bought over 13,000 Relion strips for other diabetics, for example.

2

There is some funny money stuff going on between the insurers and the test strip makers. Right now for me Accu-Chek is the "preferred" brand with my insurance program, and if I wanted insurance coverage for the Relion, I would have much higher copay (possibly the copay would be higher than the OTC cost without insurance at all!)

Clearly there is some funny-money agreement between Accu-Chek and my insurance company. I know that my insurance is covering it and I'm also sure that the "list price" is complete fiction.

This is far far worse for lab tests. I know that if I had to pay for an A1C out of pocket, it would be $70+ at the lab I use, because not too long ago I didn't have insurance and had to fork over that much for an A1C test at that lab. But when done through my insurance company, I also know the insurance company pays $5.83 for the same test. When the funny-money is a factor of ten or larger... how is a consumer to know what is the true cost? I betcha the true cost is way closer to $5.83 than $70 but it all becomes funny money so I have no idea what's going on, what number is true, what number is fiction, pretty soon it seems like it is all fiction.

3

All symptoms of the point I'm making -- imagine trying to manage any budget when you had no meaningful pricing signals. How does one decide what to buy to eat?

I do know that A/BC pays quite a bit more than $9 for 50 Freestyle strips.

4

I think we often get confused about the role that insurance companies play. The are a "payer." They make their profit by paying out less than they take in. And now that the law says they have to disburse a certain percentage of their premiums their only way to make more money is to increase volumes. So they actually want high prices for health care as long as they can make sure they can raise premiums in order to cover the added costs. This causes a huge distortion in prices. And just like Tim I have my own examples, in particular a vitamin D test which was billed at over 20 times it's actual cost.

In the end we pay for this stuff, whether it is through our premiums or the contributions of our employers. We may think our cost is only our co-pay, but it is more complicated.

5

Dave,

I couldn't agree with you more. I would have tried the relion strips by now, but
I can only only visit WalMart when traveling. Here in Chicago and previously in New York City there are no Walmarts---all right thinking people decry them as 'enemies of the poor'.

--ZZ

6

I will not shop at Walmart and actively support local small businesses as much as possible. I understand your concern Dave and would love to see a conscientious solution.

I feel like being a diabetic is one big soul wrenching compromise after another. Whether it is big pharma, big insurance, or big wholesaler, pick your bed-fellow and I guarantee it's a compromise.

7

I agree completely Dave and have been thinking seriously of switching to relion just because I don’t enjoy being a pawn in this game and I applaud Walmart for giving me that option when nobody else was willing to

8

I don't disagree that the Relion strips seem like an enticing deal. I'm not a huge WalMart fan and am sort of dependent on small meters that I can lug along when I go running. I haven't looked into theirs to see if there's one that might work but am not that interested.

I think the big problem with medical costs is health providers. An MRI is like $300 in France but is 10x that here. I think health care should be managed by the government but am also leery of that due to the shortcomings of socialized medicines in other countries. I think we have the resources to fix it but talking about plans doesn't appeal to 47-53% of the voters in the US so we don't get much done. That's a big part of the problem too!

9

Fine points. Generic meters/strips last time I checked were NOT the same in terms of clinical accuracy. Close enough maybe but not as good as the brand names (supposedly)?

What valid reason insurance companies have for requiring an entirely new meter(s), is a fine question. Kick backs... less expense... humngh.

10

Well the generic strips meet the same regulatory standards, and in my personal experience I actually switched to generic strips because they gave far more repeatably accurate results than the much more expensive “preferred” brand name (one-touch) that my insurance covered… Consumer reports also rated the generics I use (trueresult) much higher for accuracy than most name brand strips… So in some cases brand name may be better but certainly not in all. Also at work here is human nature assuming that more expensive must be better

11

Rereading your post Dave, something just struck me. Wal-Mart is selling their Freestyle Box of 50 strips for $77?

You can buy Freestyle strips for half that price from American Diabetes Wholesale, now known as ADW Online. Sounds like even Wal-Mart has no problem with price gouging in their own store if it makes their own product look more attractive.

12

no, fhs, thats the price he quoted for the freestyle strips.

13

i get my three strips a day on socialised medicine. strips here in spain are about the same price as in the usa, my accuchek strips in the pharmacy here are 84 euros for 100. theres no way i can pay that on a teachers salary.

i hate walmart but i go there whenever im back and stock up on their relion strips. ive also found that they are quite accurate. they always give me a reading about 10 points higher than my accuchek meter.

the only crap thing about them is they dont work in 40degree (C) weather, but otherwise i find them great little machines.

14

In Germany we have the market dm. It is based on the principles of anthroposophy. They offer a starter kit of meter and 10 stripes for 9€. 50 stripes cost 20€ which is far higher than the Walmart price. The meter is of low built quality but it seems to be reliable in my experience.

15

I take the opportunity to remind you all of my test stripe relabel game. Perhaps we have some new additions?

16

Yes,

50 strip box of Freestyle = $77 USD at Walmart according to Dave.
50 strip box of Freestyle = $36 USD at ADW Online.

17

The Freestyle strips are extremely accurate, and CGMs and pumps with integrated CGMs are dependent upon the data inputted from our strips. If I had an integrated pump (using Glucogon as well in a few years), I wouldn't want to depend on the Relion strips. They aren't bad, but not reliable and accurate enough for such purposes. I found better generic strips than Relion online, but they still don't compare to Accucheck and Freestyle.

The insurance companies get deep discounts on the strips they insure, so the buying public has little option but to go through insurance for their strips. The insurance companies want us locked in. They want us dependent upon 'expensive' (to us) healthcare because if we were getting it on the cheap, then we would have no need for them. I'm on MDI, and the older insulins at Walmart run $25 a vial, but for some odd reason my insurance company apparently doesn't cover them or the Relion strips. It would make sense for them to offer me a no copay option for $25 insulin and possibly for $10 strips, but then if I learned to use both regularly and was comfortable with them, I might just say to hell with insurance. Pumps have been around for a couple of decades. How hard would it be to make a generic one at $100 each coupled with some cheap insets?

My insurance company doesn't cover any of the cheap strips, including Relion. When I was misdiagnosed as a t2 and prescribed 3 or so strips a day, I opted to buy generics.

18

Dave,

First minor point: $77 is "ONLY" 8.5 X $9, not $11. If you go with ADW, the cost difference is "ONLY" 4x @ $36. (Yes, that's still a big difference if the accuracy and other factors are the same).

Second minor point: Walmart uses the Relion brand and pricing to bring customers to their stores (including online), so they will buy other things that make Walmart a profit. It's just another part of their business model (good for them, since profit isn't a dirty word). Also, Walmart probably makes a profit on Relion.

Third minor point: Most test strip manufacturers don't have the same business model available to them to make sales and profits from other lines of business as does Walmart. They need to make a profit, too.

Fourth minor point: My meter offers integration with my insulin pump and bolus calculator, plus a fairly high level of accuracy. The Relion doesn't offer the integration or bolus calculation.

Questions: Should I give up the integration to get the lowest cost?

If we all settled on the Relion and the other meter/strip manufacturers shutter their factories, would the Relion prices rise?

Would it be acceptable for insurers to say, "Hey, PWDs, we will give you a choice? Go buy your own Relion strips for $9/50, or buy your name brand strips from us for "$X" (something in excess of $9/50)."??

I also don't know that your math at the end adds up, especially without knowing what your insurers negotiated rate for test strips truly is (it may be different than what shows on your EOB), so it might not be that others are subsidizing your care to the degree you might otherwise think. Regardless, that is part of the reason why insurance companies say they have to have large pools of customers, right? All of which leads to a much more detailed economic discussion.

Thought-provoking discussion though ...

19

Perhaps.

Looking around on-line (I missed ADW, big omission!) the price for a box of 50 Freestyle strips was comparable to Walmart (Amazon, etc.).

Half that price from ADW is great, but that only makes the price differential sting less for someone w/o insurance -- it's still "gonna leave a mark", so to speak :-)

Regardless, when I'm only paying a $35 copay no matter how large my order is (1 box of 50, or 3 boxes as is my prescription -- 5 strips/day), I'm really not affected at all whether it's $77/box at Walmart, $39 at ADW. I'm a busy guy. The only time it gets my notice is when I can get 3 boxes for less than $35.

The Relion ad caught my eye for exactly this reason. It would cheaper FOR ME to simply buy 150 Relion strips every month. Regardless of my insurance.

That, of course, got me thinking about this whole thing, pricing signals, consumer behavior, etc. While there are several inferences in this thread about less-than-ethical or perhaps admirable behavior of manufacturers, insurers, retailers, it's a side-show to the facts I've presented:

  • I pay out of pocket a $35 copay for my 150 Freestyle strips every month.
  • Walgreens is not giving them to me at that price; A/BC is paying something, and I suspect it isn't trivial (like $2.50 on top of my $35). For sake of argument, let's say they're matching ADW, which is the most deeply discounted online price mentioned here so far
  • Without A/BC paying anything, I can get the same # of Relion strips from Walmart each month and save $5 out of pocket.
Clearly some here have a philosophical/ethical/ideological/political/other problem with Walmart. That's a topic for a different discussion (and over on some political site, not here!). WHO is offering these prices is irrelevant to the point I'm trying to make here.

If Relion strips were "good enough" such that treatment outcomes were not measurably affected by Relion vs. Competitor, I don't see what basis I would have for complaining if A/BC sent me a letter that they were dropping support for all other brands than Relion, and to my benefit, they will be covering them 100% going forward.

What's the argument for demanding that someone else pay mucho $$ for something I simply want, and there's no medical/scientific advantage to?

I'm not saying Relion strips fit that bill, medically/scientifically. I'm saying if.

And, as I said in my OP, I'm on a mission to find out. Frankly, I don't care what strip and meter I use as long as I get comparably accurate results. I do care, however, how expensive health care is getting, in particular D supplies, and I feel a moral obligation not to contribute to it personally.

20
The Freestyle strips are extremely accurate, ... Relion strips. They aren't bad, but not reliable and accurate enough for such purposes. I found better generic strips than Relion online, but they still don't compare to Accucheck and Freestyle.
Well, I'll be testing this proposition directly over the next few weeks, doing a side-by-side comparison, double checking BG with both meters as often as I can.

The results are for a study group of 1, so it doesn't invalidate Scott's personal experience, or anyone else's. It only applies to me. However, if I find the system to be as "accurate enough" as my Freestyle system for treating and managing my D, I will switch to it, and drop Freestyle. I'll try first to make a deal with A/BC to approve covering them 100% saving us both money, but if they just won't budge (my expectation), I'm still $5 richer each month anyway.

Mostly, though, I just don't feel right making all of you (and everyone else) pay for my desire to have Freestyle strips because I believe something about them that I can't easily demonstrate to myself.