Welcome back to our weekly diabetes advice column, Ask D'Mine, hosted by veteran type 1 and diabetes author Wil Dubois in New Mexico. Here, you can ask all the burning questions you may not want to ask your doctor.

Speaking of burn, we're all feeling it when it comes to the rising cost of essential diabetes supplies. Wil has some options to share on that front today.

 

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

Linda, type 1 from Washington, writes: I was wondering if you have heard anything as to why the cost of test strips has skyrocketed in the last three months? I usually buy my Breeze 2 test strips (box of 50) from Amazon in the case size: 12 boxes in a case, 600 total strips, typically cost around $130. This has been a lot cheaper than buying through approved pharmacies via my insurance, where one box of 50 strips runs anywhere from $45-$100. But last week, I went on Amazon to buy my strips and the price had more than doubled. I ended up buying four boxes for $100 after looking all over online for the best price. As a type 1, I test at least six times a day, so I was understandably stunned by this huge price increase. Any thoughts or answers to this price increase for strips? It feels like another smack in the face to those of us who rely on these life-saving supplies to monitor our BG’s.

 

Wil@Ask D’Mine answers: My wallet and I feel your pain. Everything in diabetes has always been crazy-expensive, even when covered, and it seems to be getting worse with each passing month. A totally paranoid person would suspect a conspiracy to force us into extinction. Of course, I’m not that paranoid.

Not yet.

Oh, but just so you know: you’re certainly not the first PWD (person with diabetes) to be covered for strips by her insurance but unable to afford the copays. Sometimes this is because our docs write a script for something other than the preferred test strip brand, so it’s worth a call to your insurance company to find out what strip they prefer. In many cases that will lower the copay. But even then, it’s the Wild, Wild West with all kinds of weird rules and exceptions that vary widely from plan to plan. My insurance, although I loathe the strip they cover, at least will give me pretty much as many as I need for one monthly copay, but I know other PWDs who suffer a copay per tub, which doesn’t seem right to me.

Historically, it didn’t matter how much of something you needed per month, you had a flat copay. Need one vial of insulin? One copay. Need two vials per month? Still one copay. But more and more, I insurance plans are moving away from monthly copays to per-unit copays, which is insane, immoral, and a subject for another day.

But I digress. As to why you’ve suddenly seen a spike in prices on Amazon: I don’t know what’s going on, and I haven’t been able to find out. If I had to guess, I’d say the short answer is greed. But while I’m no help with that part of your question, I do have several possible solutions for you.

Now, a true confession: My test strip problems have pretty much gone away. Why? Because I hardly use them anymore, thanks to the tremendous improvements in the accuracy of continuous glucose monitors. I use two strips a day to keep my Dexcom G5 calibrated, and with the self-calibrating Dexcom G6 coming to a pharmacy near me in the new future, it’s possible that by next year, I will have used my last strip.

So naturally, my first thought was to tell you it might be cheaper to use CGM, even if you had to pay out of pocket. Well, that was my first thought until I realized that the mystery economic factors affecting your Amazon strips seem to have crept into the CGM sensor market, too. For many years, the going price of a CGM sensor was around seventy-five bucks. As a lot more folks are using them, I had innocently assumed the price had come down, but like with insulin, the normal rules of economics get inverted when it comes to diabetes. CGM sensors are about the only thing my insurance company helps me with, so I didn’t notice that at some point over the last few years, the retail price of these things has nearly doubled. A recent invoice shows the retail price for CGM sensors are a whopping $141.67 each!

Of course, much of this medical pricing is bait-and-switch. Insurance companies demand discounts, so the suppliers raise the price and give a discount. No one gets hurt, right? Wrong. Cash-pay folks are screwed. Now, of course, medical device suppliers can keep the moral high ground as up until recently all citizens were required by law to have insurance, and cash-pay folks were historically uninsured law-breakers. Of course, this ignores the fact that most cash-pay patients today have insurance; it’s just that the insurance won’t cover what they need.

But just to double check, I reached out to Dexcom to see what kind of break they’d give you if you wanted to purchase sensors out of pocket, and I was told that the cash-pay rate is $299 per month. Oddly, however, they said that was for three sensors, which I can’t make sense of as the G5 sensors are approved for only seven-day wear, even if commonly stretched. Still, using their math and doubling sensor wear, your monthly cost would still be at least $50 more than you just paid to get though the month, way more that what you used to pay. BTW, Dexcom swears that they are covered by 98% of private insurers and that only 3% of their customers are cash-pay.

You might want to check if you are covered. If not, don’t give up. I’ve only just begun to fight for you.

Assuming that your doc has written a script for the type of strip that your insurance company favors, but that on your particular plan, the copays are still out of sight, you did the only thing you could do: You went outside the system and found the best price that you could. But Amazon isn’t the only place to turn. The ReliOn brand from Walmart is still a good deal, with prices at $9 for a tub of 50 strips -- even cheaper than what you’d been paying before the price hike at Amazon. My quick math shows that before you were slapped in the face this most recent time, you were shelling out $10.83 cents per tub.

While I’m oddly grateful to Walmart, an option that I actually like better is the one provided by One Drop. This is an outfit that has a sexy little meter powered by the well-regarded AgaMatrix strip, a robust app, plus help from CDEs when you need some outside advice. We reviewed their gear and services here, but it’s their approach to selling test strips that deserves a recap, because instead of limiting you, they actually encourage you to use more strips.

It’s true. For forty bucks (OK, OK, it’s really only $39.95) on their premium plan they’ll send you unlimited test strips. Yes, you read that right. Unlimited. If you test 24 times a day (and please don’t), they’d be willing to sell you the 15 tubs of test strips you’d use at the unbelievable price of $2.67 cents each. But seriously, testing six times a day, as you know, eats up about 4 tubs of strips a month. On the premium plan you’d pay $10 bucks a tub, which is still a hell of a deal, and even about a buck cheaper than what you were paying on Amazon before the price spike. So what’s the catch? 

There pretty much isn’t one. Just a precaution. That is, One Drop has learned a lesson from watching the grey market where unused test strips from one patient are sold to another patient. For that flat fee per month, they’ll give you as many as you can use, but your app has to show that you are actually using them. Still, this is more than a fair deal.

So I don’t know why the strips you were buying on Amazon went up on you, and CGM still remains realistically out-of-sight for the cash-pay crowd, but at least there are some decent prices to be had on the strips that keep us alive.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.