Imagine if you will an insulin pen that can tell you how much insulin you need to correct an errant high blood sugar. One that can suggest the size of bolus needed to cover a bowl of Mac & Cheese. One that can actually track insulin on board (IOB) like a pump, and create clear and easy-to-read reports on insulin use and carbs for your doctor...
That’s the promise of Companion Medical’s new InPen.
As you’ll see, the pen itself doesn’t really do the work. Rather, it’s the connected app that runs the show -- aside from delivering the actual insulin, that is.
The InPen is a Bluetooth-enabled ½ unit refillable insulin pen with a companion smart phone app. Except for the Bluetooth capability, the pen is pretty much a traditional metal insulin pen that accepts either Humalog or Novolog penfill cartridges. The insulin calculator and other "smart" features all reside in the app.
The FDA cleared in 2016, and in late 2017, Companion Medical announced it would start a limited launch in the U.S. Our DiabetesMine team was able to get our hands on a couple of review units to test drive, and I’m happy to share my opinions on this InPen today along with a few thoughts from my colleague and editor, Mike Hoskins.
Overall we both think that this new InPen has potential, but it has some flaws that we think should be addressed before a full nationwide launch. Opinions may vary like in all things in diabetes, but here's where we come down on this new product.
InPen's Sleek Design
First let me say, thank you for making it a half-unit pen!
The InPen is about six-and-a-half inches long, and three-quarters of an inch in diameter (only slightly larger than the pen fills it uses) and weighs less than two ounces with a full cartridge of insulin. It’s about as small and sleek as refillable insulin pens come, but like them, it’s too large and heavy for most people to carry in a shirt pocket like a fountain pen.
The pen is available in gunmetal grey, blue, and pink and is set up for either Humalog or Novolog penfills—which actually have significantly different architectures. We at D’Mine applaud Companion for launching their product compatible with both versions, unlike the defunct Asante Snap insulin pump, which launched with Humalog only, limiting their market to patients whose heath insurance companies had only big H on the formulary.
Personally, I think the pen is lovely. My first impression of it was quality. It’s nicely made, thin-ish, and has a smooth high-quality action. I like the fact that the cap is long enough to carry a sheathed pen needle attached, even though you are not supposed to do that. I just wish Companion had made it even longer so I could carry a spare needle in the snout.
Under the hood there’s some very cool tech built into the InPen. For one thing, it has a temperature sensor, and the app will alert the users if the pen has been exposed to heat levels high enough that it could affect the integrity of the insulin. InPen can also detect the difference between a needle priming “air shot” and a real injection. How does it do that? Magic, apparently (aka proprietary technology). But it works. Although the app has a provision for “canceling” a misinterpreted injection from the calculator, I never once needed to use it.
I think the pen is well-balanced and the injection action is smooth. I think the only thing I didn’t like about the pen itself is the fact that when changing cartridges, you have to screw the plunger back into the base of the pen manually. With some other pens, you just push the rod back down and you're good to go.
btw, the pen runs on a sealed, non-rechargeable battery that's guaranteed to last one year before needing replacement.
Mike Says: I completely agree with Wil that the InPen is in fact pretty slick and smooth looking. As someone who’s been using Novolog, Lantus and Tresiba pens for nearly two years now since disconnecting from my insulin pump, this new smart pen from Companion Medical gets points for style. However, one frustration that I encountered was that because of the pen’s design, it actually is a bit slippery and I am not able to grip it as tightly as the other pens I’ve used. This led to me actually being unable to fully inject 100% of my doses each time, meaning there was a unit or two that I’d have to inject a second time after re-adjusting my grip on the pen and plunger. This was annoying and could be an ongoing problem for some users.
The InPen Mobile App
The app, which is currently IOS only (although Companion says an Android version is “coming soon”) has four main screens: Home, Logbook, Reports, and Settings. The Home Page is of course the operational heart of the system, graphically showing the most recent half-day of blood sugar and insulin bolus info in an arc. As time passes, the sugar and insulin icons traverse the arc, with the insulin icons gradually changing color to signify how much insulin action remains in each dose. Insulin on board (IOB) is displayed prominently in the middle of the screen.
A large orange calculator button opens the insulin calculator where you can enter blood sugar and carbs to get a recommended insulin dose. The math that controls the recommendations comes from the Settings page where carb ratios, sensitivity factors, duration of insulin, and blood sugar targets from you and your medical team are entered. Users can change these settings, and can also create four customized time periods each day with different settings.
Prior to the InPen, I was using a NovoPen Echo with the RapidCalc app on my phone. In many ways the two systems are much the same, but RapidCalc uses sliders to enter blood sugar and carbs. I found the InPen app, with its direct “type in the numbers” interface to be much faster. I also appreciated its Home Page, which gave me a graphical representation of the insulin in play. Just being told what your total IOB is really isn’t enough. The interface let me get a better feel of how old the various doses were, and their relative sizes. Using the InPen app, I felt in better control. I also appreciate the fact that when I open the insulin calculator the cursor is already in place ready for the blood sugar number. That speeds things up.
In addition to recommending insulin doses based on blood sugar or sensor glucose readings and carbs, the app will also recommend how many carbs are needed to correct a low blood sugar based on the insulin on board and the level of the low. It also has good built-in support, including manuals and instructional videos.
The app can also be programmed with a variety of reminders, including missed dose alarms, basal reminders, BG check reminders, and a reminder to change the insulin cartridge after 28 days.
So how did I fare with those reminders, you ask? Well, yeah… I forgot to set the reminders... maybe I could’ve used a reminder for that, ironically. This seems like a nice feature and it’s good to see reminders included for those inclined to use them, but no POV on how effective they may be from this end.
Mike Says: I’m an Android guy and my iPad doesn’t have OS 10, so unfortunately I wasn't able to fully use the app (even after borrowing a compatible iPhone, but finding I could only link to the owner’s Apple Health account).
But even without full benefit, I did like the look of the logbook overall and how it allows users to key in manual data as well as directly beam it from the InPen. I setup a daily reminder for my long-acting Tresiba, and I was also able to manually key in my Tresiba dose each day. It then appeared on the home screen along with my rapid-acting doses from the InPen as well as any BGs or carb info logged into the app. One note: The app implies you can manually enter other rapid-acting insulin doses that aren't from the pen, but I actually could find no way I could to do that. As someone who uses Afrezza inhaled insulin along with my Novolog and Tresiba, it sure would be helpful to be able to include that data somewhere.
Data Sharing and (Little) CGM Connecitivity
As an ex-educator, I have to say I liked the reporting function that allows you to send data to a healthcare provider. You can choose between 7, 30, and 90 days press the “PDF” button at the top right, and the report can be quickly exported via email, text, or airdrop to your medical team. It’s super-quick and easy. By comparison, the RapidCalc app I’ve been using can only email reports, and they are in CSV format, which is a hassle to deal with.
In theory, the InPen app can communicate with Apple Heath Kit enabled meters and CGMs. In practice this doesn’t work very well, at least on the CGM front. Both myself and Mike use Dexcom G5s, but Health Kit will only report 3-hour-old data to the app, making the FDA approved-for-dosing data worthless. This is actually a casualty of the FDA only allowing for this retrospective data to be used via Health Kit right now; Dexcom’s working to get real-time data on board, but it’s TBD on when that might actually happen. So while it’s disappointing, this isn’t Companion’s fault.
The InPen system came with the latest incarnation of AgaMatrix’s sexy little Jazz meter, which can populate the insulin calculator with blood sugar data. By going into the logbook function, you’re able to key in results manually or those shared by Bluetooth via the Apple Health Kit app. I was very bummed that the CGM data was so out of date. It got me so confused after one day that I disabled it. I don’t need my sugar from three hours ago. I need to know what it is now. Hopefully in the future that will change, but right now I feel it’s disingenuous to say the InPen interfaces with CGMs.
Don’t get me wrong, the pen is great, but when it comes to connectivity, I found myself wishing that the app could talk to the pen, rather than the pen always talking to the app. I have to open the app and enter my current sensor glucose and my carbs to get a dose recommendation, which I then have to dial up on the pen to take. The pen then reports back to the app what I took and logs it, but basically the app already knows the dose, so having the pen beam it back seemed redundant to me. If the app could have somehow beamed the dose to the pen, now that would be a time-saver!
Pricetag and Accessibility
We’re told that the retail price for the system is just under $800, but that Companion is making great progress in insurance coverage.
That’s good news, but the InPen is likely to be covered on most plans as DME (Durable Medical Equipment), leaving most PWDs shouldering between 20% and 50% of the cost, depending on their plan.
That's still a big pricetag compared to $7.99 for the RapidCalc app and less than $60 for either a HumaPen Luxura HD or NovoPen Echo, both of which will last for many years.
I was having trouble justifying the coverage hassle and price tag, even though I personally received a review pen for free directly from Companion Medical (thank you!) and already had insulin cartridges at home to plug in. In other words, I didn't have to go through my insurance or pay a penny here. But Mike had a different experience...
Mike Says: Curious about cost and accessibility, I had my endo fill out the required Rx form and submit it to Companion Medical. Nowhere on that form were we asked to indicate my insurer or pharmacy provider and I confirmed with my doctor's office they had not provided that info either. Within a couple days, I received a call from California-based mail-order pharmacy Express Rx (not to be confused with ExpressScripts) that Companion is working with exclusively on this product rollout. They told me the InPen was not covered under my "pharmacy benefits" (?), therefore it would cost me the full $799, or $549 after applying a discount card.
While the discount card was appreciated, this sparked an hour-long discussion with a representative and supervisor as to how they were able to say this device "wasn't covered" for me when no one had provided my insurance information to check that. Apparently they did check just one insurer database and found an active account, but that's a different one than my wife's insurer that I actually use for my diabetes coverage.
To complicate things, this InPen device is all that was covered under my doctor's "prescriptio form." The needed Novolog cartridges and pen needles are two additional, separate prescriptions he had to fill out. But to complicate things even more, they also fall into two different categories of coverage: Durable Medical Equipment (DME) versus your prescription drug plan that covers mediciations, like the insulin itself.
After checking personally and learning that my insurer might cover this as DME with Prior Authorization, I told Express Rx quite plainly that it was misleading to charge patients hundreds of dollars without first thoroughly verifying their insurance information. So I, too, ended up receiving a review sample directly from Companion Medical instead of buying one myself through the open market. Sadly, this issue of access will remain the biggest InPen challenge, IMHO. I do believe it will scare off many PWDs who might otherwise be interested in this product.
Pump Benefits in a Pen, But Pricey
Based on all of that, here are my final thoughts of this InPen.
Yes, I like the pen. And I love the app.
It’s a great system, and it certainly delivers on its promise of bringing many benefits of insulin pumping to pen users: easy carb and dose calculation, dose tracking, data sharing, reminder alerts and more. So it's a powerful tool for insulin users who do not want to wear a pump attached to their body for whatever reason.
But one of the biggest benefits was supposed to be a lower-cost option, while it's still looking prohibitively expensive from where I sit. Although not quite as powerful or sleek, many users may be able to get a good deal of the same advantages using a clunky old pen and the $7.99 RapidCalc app.
So while I do think the new InPen has potential, there’s work to do to get into PWDs' hands at an affordable price (that justifies its benefits) and we sure hope to see that happen sooner rather than later, as Companion Medical continues its launch in more areas across the country.