Although an increasing number of people with diabetes (PWDs) are now using continuous glucose monitors (CGMs) to track their blood sugar levels, most still rely on traditional finger stick glucose meters and test strips.
People must shell out a lot of money to use these essential tools and often have a lot of questions about the real value they’re getting. What exactly do finger stick tests tell us about diabetes management? How accurate are the results? And why are they so darned expensive?
While the high cost of insulin is getting most media attention these days, these other vital supplies are a big financial burden as well.
For answers to questions about the high costs, comparative accuracy, and more, DiabetesMine took a deep dive into glucose meters and test strips. Read on:
Let’s start with the basics: Blood glucose meters and the test strips they require allow PWDs to measure and monitor their blood sugar levels at home and on the road. First developed in 1965 and used in doctors’ offices, meters and test strips started to become available for PWDs at home in 1980.
To take a blood sugar reading, the user inserts the strip into the meter and applies a drop of blood, using the “lancet” needle to poke their finger. Most meters produce a reading within seconds. The meter can store that data for later review by the PWD and their doctor.
Meters and strips are now an essential part of diabetes management for most PWDs. That includes 30+ percent of T1Ds who now use continuous glucose monitors, yet still should do finger stick tests to calibrate (reset the accuracy of) their monitors — although backup finger stick tests are not required by the Food and Drug Administration (FDA) with some of the newest CGM systems, including Dexcom G6, Freestyle Libre, and the new implantable Eversense CGM.
If you have diabetes, it’s probably a very familiar drill: You stick the test strip into the meter’s slot, prick a finger with the lancet, draw out a drop of blood, and transfer the blood to the edge of the test strip.
What happens next is pretty ingenious, even though at first glance the technology might seem old-fashioned when compared to insulin pumps, CGMs, or other new technologies for diabetes care:
The chemicals in the strip react with glucose to create an electric current, and electrons travel to the meter. The meter then determines how much glucose was required to generate that much electricity — and bingo, your BG (blood glucose) number flashes on the screen.
Actually the science behind test strips is quite complicated. They are made up of at least five different layers, including a super-thin layer of gold that helps conduct the current. Click here to see an illustration.
This has been a controversial issue over the years, because some brands of meters and strips have been shown to be more accurate than others. There’s also concern about the accuracy of models that have been out on the market for many years, so have not been tested for accuracy since their original approval by the FDA.
The California-based nonprofit Diabetes Technology Society (DTS) recently tested 18 popular blood glucose meters and compared their results to those of outside laboratories that tested the same blood specimens.
The DTS gold standard is that a meter and its test strips should yield BG readings within 15 percent or 15 mg/dl of the laboratory values at least 95 percent of the time. In several studies, only six brands passed that test for accuracy:
- Contour Next from Bayer – 100 percent
- Accu-Chek Aviva Plus from Roche – 98 percent
- Walmart ReliOn Confirm (Micro) from Arkray – 97 percent
- CVS/pharmacy Advanced from Agamatrix – 97 percent
- FreeStyle Lite from Abbott – 96 percent
- Accu-Chek SmartView from Roche – 95 percent
So there’s a whole bunch of test strips and meters out there that are less accurate than they should be. The least accurate were:
- Solus V2 from BioSense Medical – 76 percent
- Advocate Redi-Code+ from Diabetic Supply of Suncoast – 76 percent
- Gmate Smart from Philosys – 71 percent
Don’t worry: You can generally trust any glucose meter and strips to provide a result that’s within 20 percent of ideal lab values, and therefore not in any way dangerous, especially if you are not concerned about very precise insulin dosing.
But “the accuracy of results, along with ease of use and price of both the meter and strips, should factor into your decision when choosing a glucose meter,” according to experts in the DTS’
Blood glucose test strips are available over the counter at big box stores, independent retail pharmacies, and a lot of websites, including Amazon, eBay, discount pharmaceutical sites like GoodRx, and manufacturers’ on-line sites. You can also find them in the so-called “grey market” (see below).
You do not need a prescription to buy test strips over the counter in the United States. But a healthcare provider’s prescription is generally required by insurers to cover specific brands of test strips, blood glucose meters, and other supplies.
Strips are covered by most commercial insurers as well as Medicare and Medicaid. According to survey data provided to DiabetesMine by the diabetes research firm dQ&A, most PWDs do get their test strips through health insurance — 82 percent of people with type 1 diabetes, and 76 percent of those with type 2 to be exact.
But even with this coverage, test strips can often be very pricey.
For one thing, if you have a high deductible health plan, you still might need to pay over-the-counter prices for supplies (and, sadly, insulin) until you meet the deductible. However, you could catch a break if you have a health savings account, as the U.S. Treasury Department recently said that diabetes supplies — and insulin — would be covered in high deductible plans for people who have HSAs.
Also, your insurance might not cover the brand of test strips that you want. Many insurance plans put specific “preferred” brands of meters and test strips in their top “formulary tiers.” That means brands not in those tiers will cost much more.
This can be a problemfor PWDs who need specific meters that transmit readings to their insulin pumps, or who switch insurance plans and don’t like the strips and meters covered by their new plans.
Don’t lose hope if you’re in that situation. Your doctor might be able to help you get coverage for diabetes supplies by writing a “letter of medical necessity” to the insurance company. It all depends on the reasons for the denial and the guidelines of your insurance policy. Check out how to appeal insurance decisions here.
For too many PWDs, diabetes test strips cost too much!
The costs can vary dramatically, and they can add up, especially if you buy them without insurance. Prices change frequently, but to give you an idea of the range, at the time of publication, Amazon showed the following brands at these comparative costs:
· Prodigy: about $.16 per strip ($8.06 per 50)
· ReliOn: about $.18 per strip ($8.96 per 50)
· Bayer Contour Next: about $.40 per strip ($20.44 per 50)
· Accu-Chek Guide: about $.53 per strip ($26.50 per 50)
· One Touch Ultra Blue: about $1.00 per strip ($51.59 per 50)
· CVS/pharmacy Advanced: about $1.80 per strip ($89.95 for 50)
Prodigy test strips for several brands of Prodigy meters, which cost about $.16 per strip, appeared to be the cheapest at the time of our research in late September 2019.
Yes! Blood glucose test strips and meters are covered as durable medical equipment by Medicare Part B, which applies to medical services and supplies that are medically necessary to treat your health condition.
What is “durable medical equipment (DME)” and why does it matter?
DME is a classification by Centers for Medicare & Medicaid Services (CMS) for primary types of medical equipment for home use. In diabetes, items that do not have this classification are typically much more difficult to get covered by insurance.
There’s no law against buying and selling diabetes test strips on the open market. As a result, a growing “grey market” has emerged, where companies buy strips from PWDs and other sources and resell them. Go online and you’ll find more than a few outfits doing this, with names like TestStripSearch.com, QuickCash4TestStrips.com, and Stripsupply.com.
We’ve checked into the deals available at some of these companies and are skeptical. As explained in our earlier article on “Saving Money on Diabetes Medications and Supplies,” the savings here don’t appear to be that great, and given the fact that the quality control in these outfits is uncertain, we urge caution. Some sellers may try to peddle expired goods, for example.
Partly in response to this grey market, the state of California for one has begun to regulate the supply chain of diabetes products, including glucose test strips, to prevent fraud and ensure patient safety.
And the FDA issued
In other words, buyer beware.
The manufacturer’s stated shelf life of most test strips is 18 to 24 months.
As our Ask D’Mine advice column explains here, the longer you use expired test strips, the more likely you are to get screwed-up results.
That said, “most strips… can be used for a good period of time beyond their official expiration date… But at the same time, with all the variables that can impact a strip’s lifespan, and the tremendous variety of strips out there, I don’t think we have a prayer of getting a hard-and-fast rule about how long a typical strip might last.”
If you want to be a good citizen of the planet, it’s best not to throw out any medical waste in regular trash bags or public trash bins, including glucose test strips, lancets, or alcohol swabs.
Once the strips expire, it’s best to put them in dedicated bio waste containers along with other medical waste, as noted by the Diabetes Council. And here’s a good guide to separating and recycling the various components of your glucose testing kit.
I hereby confess that I’m often a bad and lazy citizen of the planet, and I throw my used and expired diabetes supplies into a garbage can along with other trash. Writing this article has prompted me to stop doing that. Thanks, DiabetesMine!
This article has been medically reviewed by Maria S. Prelipcean, MD, on 10/17/2019.