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Although many people with diabetes use continuous glucose monitors (CGMs) to track their blood sugar levels, most still rely on traditional fingerstick glucose meters and test strips.

People spend a lot of money to use these essential tools and often have a lot of questions about the real value they’re getting, including:

  • What exactly do fingerstick tests tell us about diabetes management?
  • How accurate are the results?
  • Why are they so darned expensive?

While the high cost of insulin is getting media attention these days, these other vital supplies are a big financial burden as well. Research from 2012 shows that about 27% of diabetes-related expenses at pharmacies are for self-monitoring blood sugar, including meters and test strips.

In fact, more than 38% of those with diabetes in the United States (and 33% around the world) have rationed blood glucose testing supplies, according to a 2018 survey by T1International.

We took a deep dive into questions about the high costs, comparative accuracy, and more about glucose meters and test strips.

Let’s start with the basics: Blood glucose meters and the test strips they require allow you to measure and monitor blood sugar levels at home and on the road. First developed in 1965 and used in doctors’ offices, meters and test strips became available at home in 1980.

To take a blood sugar reading, insert the strip into the meter and apply a drop of blood after using the needle to poke your finger. Most meters produce a reading within seconds. The meter can store that data for later review by you and your doctor.

Meters and strips are now an essential part of diabetes management for most folks with diabetes. That includes more than 30% of people with type 1 diabetes who now use CGMs, yet still do fingerstick tests to calibrate (reset the accuracy of) their monitors.

However, backup fingerstick tests are not required by the Food and Drug Administration (FDA) with some of the newer CGM systems, including:

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.

Even though the technology might seem old-fashioned when compared with insulin pumps, CGMs, or other new technologies for diabetes care, what happens next is pretty ingenious:

  1. The chemicals in the strip react with glucose to create an electric current.
  2. The electrons travel to the meter.
  3. The meter then determines how much glucose was required to generate that much electricity.
  4. Bingo: Your blood glucose number flashes on the screen.

The science behind test strips is quite complicated. They are made up of at least five 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 because some brands of meters and strips appear more accurate than others.

There’s also concern about the accuracy of models that have been on the market for many years and have not been tested for accuracy since their original approval by the FDA.

The California-based nonprofit Diabetes Technology Society (DTS) 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 blood glucose readings within 15% or 15 mg/dL of the laboratory values at least 95% of the time.

In several studies, only six brands passed this accuracy test:

  • Contour Next from Bayer: 100%
  • Accu-Chek Aviva Plus from Roche: 98%
  • Walmart ReliOn Confirm (Micro) from Arkray: 97%
  • CVS/pharmacy Advanced from Agamatrix: 97%
  • FreeStyle Lite from Abbott: 96%
  • Accu-Chek SmartView from Roche: 95%

So, there’s a whole bunch of test strips and meters out there that are less accurate than they should be. Some of the least accurate were:

  • Solus V2 from BioSense Medical: 76%
  • Advocate Redi-Code+ from Diabetic Supply of Suncoast: 76%
  • Gmate Smart from Philosys: 71%

Still, according to experts in the Journal of Diabetes Science and Technology, when choosing a glucose meter, you should consider the accuracy of results as well as:

  • ease of use
  • maintenance
  • price of both the meter and strips

In the United States, glucose test strips are available over the counter at big box stores, independent retail pharmacies, and many websites, including Amazon, eBay, discount pharmaceutical sites like GoodRx, and manufacturers’ online sites. You can also find them in the so-called “gray market” (see below).

Test strips are covered by:

According to survey data passed directly to us from the diabetes research firm dQ&A, most people with diabetes get their test strips through health insurance — 82% of people with type 1 diabetes and 76% of those with type 2 diabetes, 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 (HSA), as the 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 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 tiered lists will cost much more.

This can be a problem for those who need specific meters that transmit readings to their insulin pumps, or who switch insurance plans and don’t like the meters and strips covered by their new plans.

Stay optimistic 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.

Does Medicare cover diabetes test strips?

Yes! Blood glucose meters and the necessary test strips are covered as durable medical equipment by Medicare Part B, which applies to medical services and supplies necessary to treat your health condition.

What is durable medical equipment and why does it matter?

Durable medical equipment is a classification by the Centers for Medicare & Medicaid Services 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.

Glucose test strips pretty much all work the same way. You simply plug one into the glucose meter brand they are designed for and place your blood sample on the end of the strip where a tiny sensor is embedded to get a reading. The slight differences in strip brands are found in the amount of blood required, time to result, and cost.

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

  • compatible with all Prodigy meter models: Voice, Pocket, and AutoCode
  • need 0.7 microliter of blood for testing
  • results in 7 seconds
  • approved for alternate site testing (beyond just fingertips)

Cost: about $0.15 per strip

ReliOn

  • compatible with all ReliOn meter models, sold at Amazon and Walmart, made by Arkray
  • requires 0.5 microliter blood sample size
  • results in 7 seconds
  • allows fingertip or palm testing

Cost: about $0.29 per strip

CVS Health Advanced

  • compatible with the CVS Health Advanced Glucose Meter, CVS Health Advanced Bluetooth Glucose Meter, and CVS Health Advanced ProHealth Glucose Meter
  • requires 0.5 microliter blood sample size
  • results in 5 seconds
  • large, easy to handle design

Cost: about $0.22 per strip

Bayer Contour Next

  • compatible with all Contour Next glucose meter models
  • requires 0.6 microliter blood sample
  • results in 5 seconds
  • allows second-chance sampling, meaning you can apply more blood to the test strip if necessary, which may help prevent wasting test strips and save money

Cost: about $0.38 per strip

Accu-Chek Guide

  • compatible with all three Accu-Chek Guide meter models only (Accu-Chek Aviva and SmartView meters have specific strips)
  • requires 0.6 microliter blood sample
  • results in under 4 seconds
  • come packaged in a unique spill-resistant SmartPack vial that helps you efficiently take one test strip out at a time

Cost: about $0.45 per strip

OneTouch Ultra

  • compatible only with the OneTouch Ultra2 and OneTouch UltraMini meters (OneTouch Verio meters have their own brand of strips)
  • requires 0.4 microliter blood sample
  • results in 5 seconds
  • uses patented “DoubleSure Technology” that automatically checks each blood sample twice for utmost accuracy

Cost: about $1 per strip

The manufacturer’s stated shelf life of most test strips is 18 to 24 months.

Diabetes author and educator Wil Dubois explains, “most strips… can be used for a good period 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.”

He also notes that the longer you use expired test strips, the more likely you are to get inaccurate results.

What do you do with expired diabetic test strips?

If you want to be a good citizen of the planet, it’s best not to throw out 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. Read a guide to recycling and disposing of the various components of your glucose testing kit here.

Do you need a prescription to buy diabetes test strips?

You do not need a prescription to buy test strips over the counter in the United States. But insurers usually require a healthcare professional’s prescription to cover specific brands of test strips, blood glucose meters, and other supplies.

Which glucose meter has the cheapest test strips?

Prodigy test strips for several brands of Prodigy meters appeared to be the cheapest at the time of our research in August 2022.

Even among the most budget-conscious glucose meters and strips, many factors may affect your product choice. See this guide to drugstore brand glucose meters for details.

Is it legal to resell diabetes test strips?

There’s no law against buying and selling diabetes test strips on the open market. As a result, a growing “gray market” has emerged, where companies buy and resell test strips. Go online and you’ll find more than a few outfits doing this, with names like TestStripSearch.com, QuickCash4TestStrips.com, and Stripsupply.com.

As mentioned in another article, the savings here don’t appear to be that great, and given 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 gray market, California has begun to regulate the supply chain of diabetes products, including glucose test strips, to prevent fraud and ensure patient safety.

The FDA issued a warning to consumers about the safety of “pre-owned or unauthorized” test strips in April 2019. However, the agency noted that it was unaware of any deaths or serious injuries from these strips.

In other words, buyer beware.