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

Diabetes Advocacy Self Advocacy
21
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).

DOH! How could I make that mistake?
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.
Do you know this, or are you speculating/assuming? If you know it, how did you get direct information on Walmart's business model(s) and strategies?

I'd like to deal with facts here, not assumptions. Facts are pretty much indisputable -- opinion can be argued without end, and become nothing more than distraction.

22

I had an iffy experience with Relion meters. Like I have a relion confirm, and I LOVED it at first and it matched my one touch ultra mini and ultra 2 (which usually are around the same place as readings go , maybe 2-3 mg/dL difference) for a very long time, but then it stated being inaccurate beyond 50 mg/dL higher than my one touch ultra 2 where I've banished it to the back up supply drawer and don't plan to use it ever again (same place with the bayer contour next lol ) . While it's incredibly cheap for the 200 strips I'd need (I think it was like $72 for 2 boxes of 100 vs the retail $298 for 200 ultra blues) it came with the price of being inaccurate. I wouldn't want to use them for insulin doses or anything now. I mean I know I could be wrong and the ultra 2 could be the inaccurate one, but I'm inclined to disagree when the other meters have said 80's when I'm hypo and the ultra 2 says a hypo number. My a1c is 5.7% so I'd bargin that the ultra 2 is also the most accurate based on that.

While saving money is great, I don't want to risk accuracy to save money. I will find a way to get one touch strips no matter what, it ain't worth the risk of inaccuracy and giving myself a wrong insulin dose.

23
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.
Mine does too (I'm an Omnipod user). It's a very convenient feature.

Yet, it's not difficult to enter a BG value derived from a different instrument. In fact, most of my BG values stored in my PDM are not from the integrated Freestyle meter, but rather from my Dexcom CGM.

Regardless, I don't feel morally sound demanding others pay for my convenience. It seems really, really wrong. I should pay for that myself, in my opinion.

For those people that, for whatever reason, end up with worse treatment outcomes if having to use a seperate meter from their pump-integrated one, due to vision issues, RA or other dexterity problems, etc., then there is medical justification. Those few and far between would be covered for more expensive, medically necessary gear.

Questions: Should I give up the integration to get the lowest cost?
A fair question, and not one I can answer for you. Only you can answer that. In thinking about it, consider what your decision would be if, all other things being equal for you financially, you had to bear to full cost of test strips. Also please consider the ethical question of just how much desire vs. need you think others should bear the cost for you, instead of you yourself.
24

I have in the past used the Relion strips when my insurance would not cover enough strips and I was paying out of pocket. I currently use OmniPod so use Freestyle strips but I had no issues with Relion compared side by side with Accuchek. My test strips are covered 100% at no out of pocket for me so I'll be staying put.

As a side note, my insurance company will no longer cover any drug or supply that can be purchased over the counter. Nexium is no longer covered since it came out OTC and the OTC retail cost is about 60% cheaper than my copay was for the prescription.

25

But if you limit the more expensive gear to that deemed "medically necessary", one could argue that pumps and CGMs aren't medically necessary either. If the aim is the lowest cost treatment plan, then syringes and vials would be the lowest cost option. I went this route for almost 25 years myself. I've never used insulin pens because my copay was much higher for the pens when they first came out and I just stayed with syringes.

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The key here is treatment outcomes.

I know that I can not achieve the same healthy management of my D without a pump and CGM.

A choice that has no measurable impact on treatment outcome is not medically necessary. When a choice does have an impact, the debate shifts to one of cost/benefit.

I wasn't raising that issue, hence in the OP and followup posts I've never discussed a goal of "the lowest cost treatment plan", rather I've been focused on unambiguous cases of cost differential where treatment outcome is not an issue, but seemingly the only difference is convenience, desire, etc.

27

I can't disagree with anything you've said above. If there is a real, clinically significant difference in accuracy, enough to impact treatment outcomes, then a patient has a strong argument of medical necessity for a particular BG testing brand (or against one).

However, Sensorium, had your experience been different, and the Relion system was as accurate as your ultra 2, would you still insist your insurer pay for you to have the more expensive system? If they pushed back and ask you to justify why they should incur this additional expense, what would your justification be?

28

If accuracy wasn't a problem really I wouldn't care what strips I use as long as they're accurate and either don't cost me an arm and a leg regardless of insurance coverage. I don't know if my response is enough to answer that question , but insurance should cover what is best for the consumer in all ways not just financially. That might be asking a lot out if insurance, however.

I might be off here, but it shouldn't be down to cost alone. It's more risky to give diabetics (particularly insulin using ones) less accurate test strips and more costly to deal with the side effects of that in the long run.

29

No offense, but a pump and CGM are a luxury to those who can't afford them. So to say that you feel a moral obligation to sacrifice your brand of test strip doesn't scratch the surface, IMO. I mean, it's great if it makes you feel good, but CGMs are realtively new technology and lots of PWD manage well without them.

Don't get me wrong, I love my CGM and would not want to give it up. If I was 100% private pay, I would have to. As a matter of fact, when I get to Medicare status, I may have to since it's not covered.

30

Well, sure, but when you begin the discussion with how Relion is an example of how we are the problem by, and I'll definitely be diplomatic here, not buying a product "like" Relion, then it is incumbent upon you to clearly demonstrate why your position is devoid of philosophical/ethical/ideological/political/ other problems if feel like these points are to be made in a different thread. I don't think you did that, especially given Mike's points.

The bottom line is this, if we are to divorce ourselves completely from the insurance option which is really one of the few limited options we are left with if we, as the healthcare consumer, are to accept responsibility for the problem, then there has to be a viable and equivalent option for us to turn to.

There simply isn't at this time. While going for the most inexpensive option, like Relion products, helps our own pocketbook, what it effectively does is force us to turn back the clock 20 years on advances in Diabetes care. I mean, IF, I could get something like an Omnipod for 1/10 the price, or even 1/2 the price without insurance, I'm all over it.

Unfortunately, our market share is simply too small to support R&D on Diabetes management if we were simply it leave it all to market forces. If we left it to market forces, Relion would all we be left with and I have no faith in the likes of Wal-Mart to have my best interest in mind any more than I have faith in insurance companies.

If I have to go to insurance, I'm comforted by the notion that while many others are subsidizing my choice, they are at least choosing to do so as I am choosing to subsidize their choices by purchasing insurance.

So, really, it's just a crap ton of IF's.

If if were a fifth, we'd all be drunk.

31

Sam, I am a big fan of the ReliOn Prime. I don't have insurance at the moment so I have to use what is cheapest. I go to a community care clinic for my care and prescriptions but the Freestyle (which is what the clinic was providing for it's diabetic patients) company stopped providing for clinics like I go to.

1 Like
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Alas, one difference in the Omnipod vs. Roche Accu-Chek is there is no option to enter your BG manually and still use the bolus calculator. So, on my system, if I have to go with the lowest cost meter/strip, then I give up the calculator function, period.

Regarding the profit/loss on the Relion brand, I am speculating based on Walmart's well known reputation for squeezing its suppliers in order for Walmart to offer a lower price on the same/similar goods and services.

Regarding "not feeling morally sound demanding others to pay for my convenience," that is (in large part) the whole idea of insurance and large pools of subscribers. If that your view, why have insurance at all? Why not just pay for your costs and ask everyone else to just pay for theirs?

To smileandnod's point below and your response, "treatment outcomes" depends on how you define what is "successful". I think you dismissed the point a bit too easily to continue your argument. A1Cs? Number of Joslin 50-year medalists? Rate of heart attack/disease of PWDs v. Sugar-Normals? I think our current definitions of success still uses tools that are pretty crude. For example:

I have had mid 6 A1Cs on MDI and on the pump, and I am definitely certain that the pump provides me a better outcome that will be measured beyond A1C results. On MDI, I had multiple trips to the ER v. zero on a pump. I spent time in DKA on MDI v. zero on a pump. I had to eat at very specific times on MDI v. skipping any meal time I want on a pump, etc, etc.

There are studies I have read about here on TuD that show pumps may not have a clinically different outcome compared to MDI or syringe and vial. So, outcomes depends on who is doing the defining.

To your original point of "WE, the healthcare consumer, are the problem", I take issue with. Yes, "WE" might be part of the problem, but "THE" problem? Hardly, there is plenty of blame to go around.

33
Regarding "not feeling morally sound demanding others to pay for my convenience," that is (in large part) the whole idea of insurance and large pools of subscribers. If that your view, why have insurance at all? Why not just pay for your costs and ask everyone else to just pay for theirs?
Perhaps we'll have to agree to disagree on this, but insurance -- with pretty much health "insurance" being the only exception -- is a product for spreading and sharing risk where no individual in the risk pool is reasonably capable of accommodating that risk on their own.

Insurance is not about socializing the cost of desire, conveniences, or more absurdly luxuries.

As I said, medically necessary (i.e. addressing risk) costs, well in excess of that which anyone can handle, is what insurance is for.

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If accuracy wasn't a problem really I wouldn't care what strips I use as long as they're accurate and either don't cost me an arm and a leg regardless of insurance coverage. I don't know if my response is enough to answer that question
You answered it fully!
35
No offense, but a pump and CGM are a luxury to those who can't afford them
I'm not offended. I do disagree strongly with your characterization, though.

Something medically necessary for someone to live their life healthy and well is not a luxury, whether they can afford it or not. One's ability to purchase something is independent on whether or not it is needed, or simply wanted.

That said, the line between "medically necessary" and "convenience" for a pump is thin indeed. I would have a hard time arguing that others should be forced to, through their premiums, cover my pump. Rather, I'd buy a policy voluntarily that included that coverage, and pay a bit more.

However, we're straying a bit here. Pumps and CGMs are not a good comparison to test strips. A strong case can be made that pumps and CGMs result in much better control, not just because they're "convenient" (especially in the case of the CGM).

While I'm here arguing that it's irresponsible to insist on expensive test strips if they yield no medically advantageous benefit, I'm also one that has argued many times that CGMs should be available to all diabetics, covered by insurance, because they make an enormous difference in BG control if one is disciplined about using the information.

36

Iā€™ve specifically requested my insurance to cover some of the cheapest strips on the market which I preferā€¦ And my doctors office has even written a letter stating that their preferred option (one touch) didnā€™t work well for me. They refused. The whole thing is a scam. If insurance wasnā€™t messing up the whole supply and demand the cost of all strips would be comparable to what the relion brand areā€¦

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To smileandnod's point below and your response, "treatment outcomes" depends on how you define what is "successful". I think you dismissed the point a bit too easily to continue your argument. A1Cs? Number of Joslin 50-year medalists? Rate of heart attack/disease of PWDs v. Sugar-Normals?
It's not cut-and-dried, to be sure.

But then, it's not a completely opaque proposition either.

I'd simply point to Lloyd's latest article posted about longitudinal results a decade after the DCCT et al, and the lasting benefits from tighter and tighter control. This is the sort of thing I'm thinking of when I speak of "successful outcomes".

When there's a mountain of evidence that using Freestyle, Accu-Check, etc. strips over Relion strips yields indisputably better health and treatment outcomes for PWD, I'll be the first to advocate that this is what insurance covers.

Absent that, with outcomes being nominally the same, I don't see how someone demands that others labor so they can have the test strip they want, rather than just what they need.

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I don't think we are the problem at all. First of all, we need insulin to survive and we have no choice in the matter. We also don't have a say so in how much is charged for test strips in the first place even the relion brand of which I have two back up meters and strips in case my ibg star fails. The strips should be universal if possible and fit into any meter and at the least they should all have regulated low pricing, that way we can use the meters we like best and not worry about them fitting into the right meter. I use the ibg star meter because it is small and it transmits bg directly into my phone for me making my life much easier and keeping me safe. I have all my records on my phone. Even if the strips were not covered I would still use the app to have everything on my phone, but it would make things more difficult having to add in bg manually.

39

There are online retailers that sell quasi generics for about the same price as Walmart as well, so I think they are making money. American Diabetes Wholesale sells 200 of the Advocate Redicode strips for $36 (plus shipping) and they are comparable quality.

40

I actually tried relion when I was first dx and had no insurance. I bought the system and supplies a little before I ran out of my freestyle strips and compared the two out of the same ā€œholeā€/finger stick. For me the Relion on meter was at least 30 higher than my freestyle and was inconsistent so I couldnā€™t even just subtract 30 from whatever my reading was. I called the company and they told me that the amount I was off was within regulations and had me do a few more attempts at getting an accurate reading between the two meters while I was on the phone (wasting the few freestyle strips I had left in the process).

I couldnā€™t make it work for myself even when I tested it with the control solution and ended up buying my supplies online from either amazon or American diabetes wholesale.