Prescriptions for meters and supplies? Really?

[Protimenow]

I don't think this particular thread has been posted here before.

I doubt that, whatever opinions are expressed, it'll make much difference to our legislators.

But, still, I'd like to ask:

Do you agree that sale of Prothrombin testers should require a prescription?

Do you agree that the purchase of the test strips (or cuvettes) should be prescription only?

To my mind, the answer to both questions is no.

I understand that warfarin is a drug with tiny tolerances - dose too high and you could bleed out, dose too low and you can develop clots. I understand that the medical establishment is concerned that some people wouldn't be able to follow a clinician's advice, or may not be able to successfully perform a test, and keeping those few who can't handle it from being able to test or dose for themselves protects even those who are fully capable of testing (and perhaps also managing) their INRs.

The same could also probably be said for blood glucose monitors -- too much insulin can throw a person into insulin shock, too little could cause glycemic shock. In spite of this, anyone can go into the local drugstore and buy a meter and strips - often for practically nothing. (I've seen a meter, with lancing device and lancets for less than $5, and a meter with lancing device and strips for FREE after rebate.) It seems that it's the control the physician has over prescribing the Insulin that sort of helps keep people from doing too much harm to themselves.

I don't think that a person should be made to feel like a criminal because he or she wants to do home INR testing. The warfarin is available only by prescription -- why not put a bit of responsibility on the clinician, who should require a test history and dosage diary to be convinced that prescribed dosage changes are being made or that, if self-managing, the management is being performed effectively? I keep a simple 'INR Diary' on my computer that I've been adding to from day one -- there's no magic to it and anyone with a computer should be able to do the same. Most meters also keep a history of 30 or more tests -- if a clinician has doubts about INR history, a glance at the meter should provide some answers. My INR diary also includes weekly dosage information and other information about diet, activity and medication changes, but should be easy for most people to create and manage on their own.

This isn't to say that the current methodologies that Alere and Philips implement -- supplying the meters and strips, and reporting readings to the doctors -- isn't working, or shouldn't continue, but for people who don't have insurance to cover these services, or who just want to do their own monitoring (whether or not they manage their dosing), why shouldn't they also be able to do this without requiring a prescription for meters and strips?

I'm curious what others may think.

 

[Philip B]

Bleeding Out?

Bleeding Out?

How do you define tiny tolerances? Opinions probably will vary, but I'm not sure I agree with some of your commentary.

I suspect if a coumadin user was in danger of bleeding out, the injury would be pretty significant... something involving that much loss of blood would probably put even non-coumadin users at risk of bleeding out.

Sorry if I'm on the wrong track or misunderstanding your comments, but coumadin use doesn't make me fragile. I work and play as hard now as I did before I became a coumadin junkie.

-Philip

 

[bigsidster]

I think that if the insurance companies are not covering the cost of the machines (testers) then they should be sold without the need for a perscription.If thee insurance company is paying for it I have no problem seeing the doctor for the prescription.

 

[Protimenow]

Philip:

I agree - taking too much warfarin shouldn't be considered much of a risk for bleeding out. However, some in the medical profession seem to think that patients may make major errors in self dosing -- or even in administering the dose prescribed by a doctor. We have a thread right now where a patient just a few weeks post-op was taking only 2.5 mg/day - her INR was low - and she was told to QUADRUPLE her dose one time, then apparently to drop back to the dosage that was previously inadequate. The fear of some in the medical community, as I understand it, is that a person may double, quadruple, or otherwise increase the warfarin enough to cause INTERNAL bleeding - blood in the urine (kidney or bladder issues), blood in the stool, or other perhaps fatal bleeding (like brain hemorrhages). The fear is that there isn't a lot of leeway between keeping a safe INR, and pushing it to potentially fatal levels. The fact that warfarin was used in the past as a rat poison certainly doesn't help allay the fear that it's easy to overdose on the stuff and cause fatal bleeding.

Personally, I don't see that as much of a risk because it's the physicians who still have to prescribe the warfarin. The physician can choose the dosage and number of pills that the patient can have at home -- and, if the physician or someone in his or her office wanted to, they could probably confirm that the patient could be trusted to take the right dose each day (maybe prescribing a week's worth of warfarin at a time until they trust the patient to be able to handle 30 or 90 days' worth without killing him or her self).

Being a little cynical about this, I wonder if the medical establishment isn't protecting a source of income -- if a patient has to come in to a doctor's office or lab to be tested, there's the cost of an office visit plus the cost of a 'consultation.' If a person could test at home, a doctor may not be able to charge for a three minute phone call to review the latest INR results. This may be protecting a source of income for the medical establishment that self-testing pretty much eliminates.

Besides -- the tester and the strips (cuvettes) are a tool. They help the user to determine the INR at the time they are testing. That's all. The testers don't prescribe dosage changes. They don't count out the pills for the patient. In some ways they're no different from blood glucose meters that show instantaneous blood glucose levels, or even, perhaps, a tachometer on your car's dashboard that tells you how fast your engine is spinning.

I personally don't really understand why a meter should be so carefully controlled. Plus, if controls were removed, isn't it possible that a lot more people would be self-testing, and wouldn't this extra volume of testers (if not necessarily of supplies) help to drive the price of the machines down so that MORE people who wanted to self-test could afford the meters?

Phillip -- I also agree that taking coumadin doesn't make you fragile. I've been taking it for 19 years. I'm certainly not suggesting that it makes you fragile, and I don't buy into the fears that others have of the drug. It's easy to manage - if the INR is regularly monitored - and I haven't curtailed my activities either. It's the IMPRESSION that some people have of it that seems to make them think it's important to regulate EVEN the testing of blood INR.

---

Bigsidster -- I sort of see where you're coming from on this, but I don't really see an essential connection between the need for a prescription and the reimbursement by insurance carriers. I've seen plans where the insurance carriers pay mileage to and from hospitals and medical offices (and if they don't, these costs can be deducted as medical expenses on your Income Tax return). The meters and strips probably ARE deductible from annual income taxes because they're medical devices - whether or not a prescription was necessary in order to be able to buy them.

I would expect that the insurance companies may not want these to be devices that require prescriptions so that it may be EASIER for them to deny reimbursement requests. You'd think that they would WANT the meters to be available over the counter if it means they don't have to reimburse their insureds for meters or supplies. From what I've read, they sure seem to work hard to avoid having to pay for home testing for many of their insureds.

Your statement that 'if the insurance company is paying for it I have not problem seeing the doctor the prescription' makes some sense - but what about the uninsured who wants a meter? (I currently have no insurance, so I couldn't expect insurance company reimbursement -- should I be prevented from getting a meter just because some insurance companies might reimburse their insureds? What about those without insurance? Should insurance issues be used to determine what should or shouldn't require a prescription? Isn't protecting the public the primary goal of controlling prescription drugs or, in this case, meters?).

In other words - all other things being equal - regardless of form of payment - do you think the sale of meters and strips for INR testing should REQUIRE a doctor's prescription? (Obviously, the medication should be prescribed by doctors - just as Insulin is (I'm pretty sure), but why should the Feds control the sale of meters and strips?).

---

I appreciate your comments. I really do. I look forward to seeing the opinions of others.

---

I'm rather passionate about my feelings that INR testing and management should be available to anyone who takes warfarin - regardless of ability to pay or insurance coverage. Making access to meters and test supplies easier may help empower those who have to travel long distances for testing, or who have difficulty getting to test locations, or others, by allowing them to self-test. Actual INR management and prescribing can still be left to physicians or those at anticoagulation clinics or other clinics who are able to effectively manage patient dosing, or for those who are able to come to this forum and ask for help (or download dosing charts).

 

[catwoman]

CPAP machines are available only by Rx. My husband has one and even needs Rxes for replacement masks, hoses, etc. Perhaps that's so insurance will cover it, but I don't think so.
I have a Devilbiss Pulmo Aide nebulizer that I use on my cats. I can't buy parts w/out an Rx for those.

INR testers and supplies should be available only with Rxes. A doctor is probably the person best qualified for determining whether a given patient is compliant and is a candidate for home-testing. That said, some doctors oppose home-testing and patients adjusting their own dosages. Not necessary due to a loss in revenue, but more to a concern for the patient's safety.
Thank God my doctor's not like this. However, the day will come when he retires and I'm sure I'll have a new one. I have 7 years' experience of home testing and about 6 years of adjusting my dosages, and that will be a good selling point for my case by then.

 

[Bina]

It doesn't bother me either way....I got a brochure from Roche, gave my doc a "presentation" and got my RX within
a few minutes. Paid for the monitor myself, but got a tax break at the end of the year.

 

[gjgaudia]

Dear "Protimenow",

Here is a copy of an article I have been trying (unsuccessfully) to have printed in a medical journal. I have also sent a copy to Secretary of Health Sibelius, with no response.


The Fifty-Thousand Dollar Phone Call
By Gil Gaudia, Ph.D.
Abstract: Medicare patients who require anticoagulation are told by medical equipment distributors that they cannot buy, but rather must accept “on loan” measuring devices for prothrombin time. Employing what they describe as “Evaluation and Management” they require the patient to call them with each INR test result, which they then transmit to the physician. For this “patient service” they bill Medicare between $200.00 and $300.00 per month and over the lifetime of a hypothetical fifty-year-old patient the suppliers will have received as much as $50,000.00 in Medicare payments for a device that cost them around $1000.00. Not a bad arrangement . . . if you are not a taxpayer.

The Fifty-Thousand Dollar Phone Call

Several articles in medical journals have pointed to the many benefits of home monitoring of prothrombin time for patients who must be anticoagulated. An estimated two million people are currently taking Warfarin, or the brand name Coumadin, the most frequently prescribed anticoagulant drug. Because of the inherent dangers of incorrect dosing, patients are advised to have frequent blood tests to ascertain the amount of anticoagulation the drug is providing. Too much warfarin may lead to potentially fatal bleeding. Too little and the protective effect of preventing blood clots is lost, resulting in greater risk of stroke or other cardiovascular problems. Since the drug has a long half-life, and because many factors such as diet, alchohol usage, other medications and idiopathic patient factors can affect the way warfarin works, many patients find it difficult to maintain the proper level of anticoagulation and thus the dosage of their medication. The only way to be safe is to have frequent blood tests to measure the warafin’s effect on coagulation, called prothrombin time, (PT) and for many years this required a venous draw. The results are usually reported as an INR (International Normalized Ratio) which ranges from around 1.0 in normal individuals to a targeted range of from 2.0 to 4.0 in patients with varying anticoagulation needs. For people who suffer from atrial fibrillation, the range is usually set at 2.0 to 3.0. As with most lab tests, for many years, the patients did not get the results for several days, during which time if they are out of the safe therapeutic range, they are at risk for bleeding or stroke. Studies have shown that many patients were more often out of range than in.
Point-of-care (POC) testing for prothrombin time, in doctors’ offices and anticoagulation clinics, using a simple finger stick instead of a venous draw, made it possible for individuals who needed to be on long-term anticoagulation to get instant feedback on their anticoagulation and moreover eliminated almost all of the discomfort (as well as risk) associated with the drawing of venous blood. This procedure yields an accurate and instantaneous measure of the blood-clotting time of at-risk individuals using a small hand-held monitor similar to the ones used by diabetics to monitor their glucose levels. It has since become available for use in the home by those individuals who prefer to perform the procedure themselves with the consent of their doctors, and research shows that these patients benefit from the greatest amount of time spent within the targeted INR range.
In 2008, Medicare added atrial fibrillation to the list of disorders for which they reimbursed patients for the use of INR Measuring devices, and as a result, the picture appeared to become immeasurably brighter for those patients who must rely on warfarin therapy for survival. By 2005 virtually all studies on patient self testing had showed that “(these devices) are effective methods of monitoring oral anticoagulation therapy, providing outcomes at least as good as, and possibly better than, those achieved with an anticoagulation clinic” and that “(c)urrently-available self-testing/self-management devices give INR results that are comparable with those obtained in laboratory testing.
When my wife developed atrial fibrillation in 1998, we began a years-long regimen of weekly visits to the physician’s office, and then later an anticoagulation clinic. We became slaves to the schedule of blood-tests and she found it necessary to undergo the pain of the weekly venous draws in black-and-blue arms that had already been too frequently punctured in the course of other related and unrelated disorders. When these self-testing monitors became FDA approved for home use, our physician (and all ethical physicians) welcomed this development because she felt we were able to competently monitor our anticoagulation at minimal cost and effort to us and the doctor.The benefits were huge for those of us who were able to learn to use the device not only in terms of better accuracy in maintaining the therapeutic range and the resultant reduction of adverse events associated with improper dosing, but in reducing the trauma to tortured arms, as well as eliminating the inconvenience of weekly trips to the physican’s office.
So, what’s the problem? The answer is that it there are some hidden catch-22s in the procedure for obtaining the monitors that have provided a convenient source of extravagant income for those who deal in the manufacture and distribution of the equipment. Somehow, it was decided that patients would be told that they could not purchase the monitors under Medicare’s “Coverage, Guidelines and Payment Methods; E and M code” and expect Medicare reimbursement, but rather they must accept them as a benevolent loan from the supplier who charitably wanted only to charge an E and M fee (Evaluation and Management). As an additional requirement patients are told that they must call in the results after each home test to the supplier who then bills Medicare for the “service” of relaying the results to the doctor. This is the “M” or “management” portion of the E and M code. In actuality, there is very little of either evaluation or management, because the providers neither evaluate nor manage the INR results, but merely report them to the patient’s doctor, either by Fax or by phone. In our case Medicare is billed $200.11 per month or $2401.32 annually. Since we have been using this meter for two years Medicare has paid over $4800 for a meter they could have purchased for a third of that amount and will continue paying for the foreseeable future. In the hypothetical case of a younger individual, say a fifty-year-old patient, who might have a life expectancy of over twenty-five years, the cost to Medicare for a $1500.00 device could well exceed $50,000.00! Even at my wife’s age of eighty, Medicare has already paid almost three times its cost and it is not unreasonable to assume they will pay that amount over again.

All of this can be traced to the maze of bureaucratic guidelines surrounding what Medicare calls “Durable Medical Equipment (DME)” and the “Coverage, Guidelines and Payment Methods” they have concocted with the help of lobbyists from the many industries that benefit from the huge profits that are obtained by “lending” rather than purchasing equipment. The durable medical equipment companies have created a market which has become the gift that never stops giving for them. Since most units’ retail cost is paid for in less than one year of reimbursement fees, suppliers can count on many years of steady and reliable income at taxpayers’ expense. One of the DME providers’ threats is that they won't service the machines that are purchased rather than accepted “on loan.” They also warn that if there is a “recall” people who may have bought the machine elsewhere, would not be notified and therefore would be at risk of relying upon defective devices. But these machines are usually maintenance-free and an engineer from one of the companies’ technical department told me they generally will perform for least 3 years without any problems at all The obligation to call the supplier every week for the rest of one’s life is an onerous responsibility especially considering that in the case of our supplier, “Disetronics,” the failure to comply elicits an automated telephone reminder and threat that the service will be discontinued if compliance is not maintained
Currently there are three competing manufactures of monitors for patient self testing (PST) Hemosense, Roche Diagnostics and ProTime ITC, who somehow have managed to manipulate lucrative and convenient guidelines from Medicare which generates millions of dollars in income for them by simply making a telephone call. No sane business person would ever agree to pay a perpetual rental fee for an easily affordable item, but the business minds at Medicare must have had some very persuasive lobbying from interested parties.

 

[gjgaudia]

The Fifty-Thousand Dollar Phone Call

The Fifty-Thousand Dollar Phone Call

Dear "Protimenow",

Here is a copy of an article I have been trying (unsuccessfully) to have printed in a medical journal. I have also sent a copy to Secretary of Health Sibelius, with no response.


The Fifty-Thousand Dollar Phone Call
By Gil Gaudia, Ph.D.
Abstract: Medicare patients who require anticoagulation are told by medical equipment distributors that they cannot buy, but rather must accept “on loan” measuring devices for prothrombin time. Employing what they describe as “Evaluation and Management” they require the patient to call them with each INR test result, which they then transmit to the physician. For this “patient service” they bill Medicare between $200.00 and $300.00 per month and over the lifetime of a hypothetical fifty-year-old patient the suppliers will have received as much as $50,000.00 in Medicare payments for a device that cost them around $1000.00. Not a bad arrangement . . . if you are not a taxpayer.

The Fifty-Thousand Dollar Phone Call

Several articles in medical journals have pointed to the many benefits of home monitoring of prothrombin time for patients who must be anticoagulated. An estimated two million people are currently taking Warfarin, or the brand name Coumadin, the most frequently prescribed anticoagulant drug. Because of the inherent dangers of incorrect dosing, patients are advised to have frequent blood tests to ascertain the amount of anticoagulation the drug is providing. Too much warfarin may lead to potentially fatal bleeding. Too little and the protective effect of preventing blood clots is lost, resulting in greater risk of stroke or other cardiovascular problems. Since the drug has a long half-life, and because many factors such as diet, alchohol usage, other medications and idiopathic patient factors can affect the way warfarin works, many patients find it difficult to maintain the proper level of anticoagulation and thus the dosage of their medication. The only way to be safe is to have frequent blood tests to measure the warafin’s effect on coagulation, called prothrombin time, (PT) and for many years this required a venous draw. The results are usually reported as an INR (International Normalized Ratio) which ranges from around 1.0 in normal individuals to a targeted range of from 2.0 to 4.0 in patients with varying anticoagulation needs. For people who suffer from atrial fibrillation, the range is usually set at 2.0 to 3.0. As with most lab tests, for many years, the patients did not get the results for several days, during which time if they are out of the safe therapeutic range, they are at risk for bleeding or stroke. Studies have shown that many patients were more often out of range than in.
Point-of-care (POC) testing for prothrombin time, in doctors’ offices and anticoagulation clinics, using a simple finger stick instead of a venous draw, made it possible for individuals who needed to be on long-term anticoagulation to get instant feedback on their anticoagulation and moreover eliminated almost all of the discomfort (as well as risk) associated with the drawing of venous blood. This procedure yields an accurate and instantaneous measure of the blood-clotting time of at-risk individuals using a small hand-held monitor similar to the ones used by diabetics to monitor their glucose levels. It has since become available for use in the home by those individuals who prefer to perform the procedure themselves with the consent of their doctors, and research shows that these patients benefit from the greatest amount of time spent within the targeted INR range.
In 2008, Medicare added atrial fibrillation to the list of disorders for which they reimbursed patients for the use of INR Measuring devices, and as a result, the picture appeared to become immeasurably brighter for those patients who must rely on warfarin therapy for survival. By 2005 virtually all studies on patient self testing had showed that “(these devices) are effective methods of monitoring oral anticoagulation therapy, providing outcomes at least as good as, and possibly better than, those achieved with an anticoagulation clinic” and that “(c)urrently-available self-testing/self-management devices give INR results that are comparable with those obtained in laboratory testing.
When my wife developed atrial fibrillation in 1998, we began a years-long regimen of weekly visits to the physician’s office, and then later an anticoagulation clinic. We became slaves to the schedule of blood-tests and she found it necessary to undergo the pain of the weekly venous draws in black-and-blue arms that had already been too frequently punctured in the course of other related and unrelated disorders. When these self-testing monitors became FDA approved for home use, our physician (and all ethical physicians) welcomed this development because she felt we were able to competently monitor our anticoagulation at minimal cost and effort to us and the doctor.The benefits were huge for those of us who were able to learn to use the device not only in terms of better accuracy in maintaining the therapeutic range and the resultant reduction of adverse events associated with improper dosing, but in reducing the trauma to tortured arms, as well as eliminating the inconvenience of weekly trips to the physican’s office.
So, what’s the problem? The answer is that it there are some hidden catch-22s in the procedure for obtaining the monitors that have provided a convenient source of extravagant income for those who deal in the manufacture and distribution of the equipment. Somehow, it was decided that patients would be told that they could not purchase the monitors under Medicare’s “Coverage, Guidelines and Payment Methods; E and M code” and expect Medicare reimbursement, but rather they must accept them as a benevolent loan from the supplier who charitably wanted only to charge an E and M fee (Evaluation and Management). As an additional requirement patients are told that they must call in the results after each home test to the supplier who then bills Medicare for the “service” of relaying the results to the doctor. This is the “M” or “management” portion of the E and M code. In actuality, there is very little of either evaluation or management, because the providers neither evaluate nor manage the INR results, but merely report them to the patient’s doctor, either by Fax or by phone. In our case Medicare is billed $200.11 per month or $2401.32 annually. Since we have been using this meter for two years Medicare has paid over $4800 for a meter they could have purchased for a third of that amount and will continue paying for the foreseeable future. In the hypothetical case of a younger individual, say a fifty-year-old patient, who might have a life expectancy of over twenty-five years, the cost to Medicare for a $1500.00 device could well exceed $50,000.00! Even at my wife’s age of eighty, Medicare has already paid almost three times its cost and it is not unreasonable to assume they will pay that amount over again.

All of this can be traced to the maze of bureaucratic guidelines surrounding what Medicare calls “Durable Medical Equipment (DME)” and the “Coverage, Guidelines and Payment Methods” they have concocted with the help of lobbyists from the many industries that benefit from the huge profits that are obtained by “lending” rather than purchasing equipment. The durable medical equipment companies have created a market which has become the gift that never stops giving for them. Since most units’ retail cost is paid for in less than one year of reimbursement fees, suppliers can count on many years of steady and reliable income at taxpayers’ expense. One of the DME providers’ threats is that they won't service the machines that are purchased rather than accepted “on loan.” They also warn that if there is a “recall” people who may have bought the machine elsewhere, would not be notified and therefore would be at risk of relying upon defective devices. But these machines are usually maintenance-free and an engineer from one of the companies’ technical department told me they generally will perform for least 3 years without any problems at all The obligation to call the supplier every week for the rest of one’s life is an onerous responsibility especially considering that in the case of our supplier, “Disetronics,” the failure to comply elicits an automated telephone reminder and threat that the service will be discontinued if compliance is not maintained
Currently there are three competing manufactures of monitors for patient self testing (PST) Hemosense, Roche Diagnostics and ProTime ITC, who somehow have managed to manipulate lucrative and convenient guidelines from Medicare which generates millions of dollars in income for them by simply making a telephone call. No sane business person would ever agree to pay a perpetual rental fee for an easily affordable item, but the business minds at Medicare must have had some very persuasive lobbying from interested parties.

 

[gjgaudia]

I apologize for accidently posting the same long article twice.

 

[ShezaGirlie]

Gil ~ a warm welcome to you and we're happy to have you aboard. You have described the Medicare/Insurance Company/DME Provider scheme head on and what a racket it continues to be. With the new Medicare fraud task force http://www.stopmedicarefraud.gov/ we can only hope this Medicare/Insurance Company scheme of abusing taxpayer dollars will be brought to light..!

 

[dick0236]

........ No sane business person would ever agree to pay a perpetual rental fee for an easily affordable item, but the business minds at Medicare must have had some very persuasive lobbying from interested parties.

I agree with everything you say. I am in the process of returning to my cardio for testing in his INR clinic. I have tried "home monitoring" twice, once with Raytel(Phillips) and once with Alere(QAS). While the service is convenient, it has been a "pain in the A--" dealing with the equipment suppliers.....and to "top it off", my former PCP (who prescribed the service) has left the practice and my new PCP(soon to be replaced) will not approve home monitoring. My Cardio suggested his INR clinic, which is a "walk-in" (no appointment needed) and I will have $0 copay at least thru 2011. At some point this service may become as widespread as diabetic monitoring and I might try it then.

 

[Cris N]

In addition to the medicare fraud link I would probably send it to state insurance commissioners and to AARP.

 

[Protimenow]

Gil:

I'm pleased to see what you wrote.

I think you're condemning the manufacturers for what the 'services' are doing. I think that the manufacturers are only getting their sales price plus their price for the supplies and it's the Aleres and others who are getting the windfall profits.

I've advocated for coagulation clinics that serve anyone on warfarin - regardless of income. If the person has insurance, insurance is billed. If the person doesn't have insurance, a nominal charge is made. If they can't afford the nominal charge, the testing can be free. Maintenance of a person on generic warfarin shouldn't cost more than five or six dollars a month.

I'm also a proponent of home testing. I believe that anyone who is taking warfarin, and who is capable of learning how to use the meters should be able to do so. And, if the person is capable of managing the anticoagulant dosage (and not everyone is), they should be allowed to do so - with regular reports submitted to their physicians so that compliance and effective management can be confirmed.

I've been happily self testing and self managing for about 18 months. Unlike many self-testers, I bought my meter(s) on eBay. A doctor friend purchased the testing supplies. I maintain a spreadsheet that has date, time, current dosage, current INR, current Prothrombin time, meter used (I have more than one), and any unusual activities that could have effected my INR. This information provides a useful historical record - and could also be provided to a doctor to confirm that I've tested regularly and haven't made any strange dosage adjustments. I'm not suggesting that ANYONE buy a meter on eBay -- I did, and the meters worked well. (There's one minor exception that I may write another post about). I don't know if medicare will reimburse you for meter or strips, but this may be something worth looking into (although I suspect that others on this forum may already have the answer).

I know the idea of enabling the sale of meters and supplies without a prescription is controversial to some people. It's a major public health issue. I personally don't think that the meters or supplies should be by prescription only -- but that the warfarin should be, if only to give the person or clinic prescribing the warfarin confidence in the person's accurate use of the machine and/or effective management.

(When compared to glucose monitors, I suspect that it's a lot easier for a diabetic to do major damage from under or over dosing insulin - possibly causing rapid death - than it is to make major errors in warfarin dosing. Plus - if an error in warfarin dosing is discovered, there are ways to deal with these errors.)

 

[olefin]

I have tried "home monitoring" twice, once with Raytel(Phillips) and once with Alere(QAS). While the service is convenient, it has been a "pain in the A--" dealing with the equipment suppliers.... .

Dick, what has been your problem with equipment suppliers?

I've been with QAS/Alere ever since been home testing and never had a problem with anything. I've never had to deal with any equipment supplier. Alere takes care of my supplies. I rate them Super in everything. They keep me 3 months ahead in supplies.

 

[yotphix]

The idea of a prescription being required for a meter is a little absurd to me. To have them required for supplies is doubly so. If you have the meter, you should be able to get the test strips and why would you be asking for them if you don't have the meter? In truth, I purchased the meter from my pharmacist and brought him my prescription the following day after taking the meter to my doctor to show him what I needed the prescription for! The last time I bought test strips I bought them online from a medical supplies distributor for about half what the pharmacy charges, no prescription required. I do understand that a prescription makes it possible for insurance to pay, not unlike having the doctor prescribe your Aspirin so it is covered.
As to the warfarin, it is obviously dangerous but no more so than any number of toxins we can purchase without restriction at the drugstore, or even the hardware store. I would prefer that it was behind the counter but available to any adult asking for it. Who on earth would take the stuff if they didn't need to? Keeping it behind the counter would allow the pharmacist to get a sense of whether you know what it is and what you are doing with it. I order it online now with prescriptions though I scan the scrips and send them as PDFs so it would be a snap to fake them if I was so inclined, or if I was unable to get to the doctor's. (I haven't done that, I swear, it just occurred to me once thats all!)

 

[Protimenow]

Yotphix: I'm with you. I started the thread asking if others thought a prescription should be required for meters or supplies. I'm in agreement with you.

I've saved money on my strips by buying them (or having a doctor friend buy them) from a supply house. I don't think the pharmacies would go out of business if people didn't buy the strips from them.

As far as prescription warfarin -- I have to confess that at one time I bought some from a pharmacy in India - but monitored my INR to be sure that they were biologically equivalent (they were). (The idea, too, is that these medications were made for patients in India and probably elsewhere in the world -- a pharmaceutical company wouldn't stay in business for long if it made bogus medications that didn't work or that harmed those who used them). Target, WalMart, Ralphs (Kroger), and probably other pharmacies sell the generic for $10 for 90 pills - almost the same as what the Indian pharmacy charged. I'm not uncomfortable with the idea of needing a prescription for Warfarin (as long as the person getting the warfarin actually has a doctor to prescribe it and knows how to correctly manage the INRs), because there may be some potential for abuse (sounds like a subject for a crime novel). Your idea about a pharmacy having it behind the counter would probably work, too -- but it may be a bit harder for them to dispense because of the many different strengths available.

 

[bvostok]

Do you agree that sale of Prothrombin testers should require a prescription?

Do you agree that the purchase of the test strips (or cuvettes) should be prescription only?

Situation in Germany and I think it is the best solution:
The device itself, lancets and test stripes can be purchased by anyone in certified drug stores. (Here a drug store is a shop maintained by a person who studied medicine at university and not some sort of a supermarket as in the US)
Health insurance covers any costs if these conditions are fulfilled:
- Medical requirement (i.e. mechanical heart valve etc)
- The patient participated in a course where it is taught how to operate the device (usually at a hospital or rehab clinic)
- The patient wants to do the self-management to measure the INR (for example many older people prefer to go to doctor and would not trust a technical device at home)

Regarding Phenprocoumon, Warfarin etc a prescription by a doctor is required. Not freely available, because it is a "serious" drug and could easily commit suicide with it...

 

[ShezaGirlie]

Hi there "bvostok" and Willkommen..!

 

[wcasey5]

As far as prescription warfarin -- I have to confess that at one time I bought some from a pharmacy in India - but monitored my INR to be sure that they were biologically equivalent (they were). (The idea, too, is that these medications were made for patients in India and probably elsewhere in the world -- a pharmaceutical company wouldn't stay in business for long if it made bogus medications that didn't work or that harmed those who used them). Target, WalMart, Ralphs (Kroger), and probably other pharmacies sell the generic for $10 for 90 pills - almost the same as what the Indian pharmacy charged. I'm not uncomfortable with the idea of needing a prescription for Warfarin (as long as the person getting the warfarin actually has a doctor to prescribe it and knows how to correctly manage the INRs), because there may be some potential for abuse (sounds like a subject for a crime novel). Your idea about a pharmacy having it behind the counter would probably work, too -- but it may be a bit harder for them to dispense because of the many different strengths available.

I just got a notice from my mail in drug company that my carvidilol is now being supplied from india instead of vermont. There is probably no difference.

 

[perrypiratesdad]

I too don't agree that you should require an Rx for the supplies and tester, but then maybe the reason being is to ensure that the user follows the advice of their MD. Meaning, if I didn't need an Rx to get one, I could go to Acme Tester Store, drop my money down and buy one, and then just assume I could just test and maintain my own levels. We all know there is a lot more to it than that, and the user need to know how to test, and what the results mean as well as how to properly adjust doses when an adjustment is warranted.