Last autumn, on October 9, 2023, the electronics retailer Best Buy announced (see https://www.businesswire.com/news/home/20231009526652/en/Best-Buy-to-Sell-Continuous-Glucose-Monitoring-Systems/ for the press release) that it had started a mail order business called "Best Buy Health" https://wellness.bestbuyhealth.com/ which it said would sell CGM sensors among other products. Best Buy Health aims to sell more than just CGM sensors. Its LinkedIn page https://www.linkedin.com/company/best-buy-health/ describes the business this way:
"Best Buy Health aims to enrich and save lives through technology and meaningful connections. Our strategy focuses on three main areas: consumer health products that help customers live healthier lives, device-based emergency response services for the active aging population, and virtual care offerings that help to connect patients and physicians."
Right now, on CGM supplies, it appears that Best Buy Health is ONLY selling Dexcom CGM sensors, but it is not currently selling CGM sensors from Abbott Freestyle Libre (which sells more CGM sensors on a worldwide basis than Dexcom does), or the Medtronic Guardian™ Connect CGM System. Considering this week, Dexcom made its big announcement (see its press release at https://www.businesswire.com/news/home/20240305044213/en/ for more) about its new Stelo CGM product aimed at the Type 2 diabetes patient audience which will be sold Over-the-Counter (OTC) because most commercial healthcare insurance companies refuse to cover CGMs for patients with Type 2 diabetes who are not using insulin because the economics of covering CGMs for that population simply do not work for the insurance companies, Dexcom decided to make it OTC and bypass the whole insurance mess. I don't see that Best Buy Health is currently selling Dexcom Stelo CGMs as OTC products (Dexcom says "Stelo will be available summer of 2024"), so once its available, that could soon.
But when Best Buy Health was initially announced, the press release revealed that it was a collaboration with an entity known as Wheel, which describes itself as "a virtual care platform focused on delivering consumer-centric care" as well as another entity known as HealthDyne, a "pharmacy technology provider" which is actually owned by the smaller PBM known as WellDyne (to learn more about the WellDyne PBM/HealthDyne ownership arrangement, visit https://www.prnewswire.com/news-releases/announcing-healthdyne-a-powerful-new-accelerator-for-pharmacy-solutions-301509580.html for more).
Presumably, the HealthDyne (WellDyne) partnership was arranged in order to enable Best Buy Health to sell Dexcom sensors so that patients would be able to use their insurance to pay for the sensors sold by Best Buy Health. As a side note, I have also discovered that some mail-order prescriptions for low-cost generic drugs (specifically for my statin known as rosuvastatin calcium which my insurance company feels entitled to charge me a ridiculous amount for, so I just bypass them and save a ton of cash in the process) ordered from Mark Cuban Cost Plus Drug Company have, at least occasionally, been filled by HealthDyne's mail order pharmacy. As long as the price is cheap enough, I don't particularly care who fulfills the order.
One reason to consider Best Buy Health is if its Dexcom CGM prices are marginally lower than selected big pharmacy chains including CVS Pharmacy, Walgreens and Rite Aid (but because the PBMs prevent any public disclosure of the true prices, its really hard to comparison shop based on price; that's really quite a business model, isn't it?). However, a quick look suggests that Best Buy Health's Dexcom prices seem to be merely comparable to Costco Pharmacy's prices. You may recall that a few years ago, I studied how Costco was able to successfully remain in the pharmacy business while even bigger retail rivals like Target bailed out by selling its pharmacy business to CVS. Catch my coverage of Costco's pharmacy strategy at https://blog.sstrumello.com/2023/01/costco-pharmacy-what-is-its-pharmacy.html for more, and what I discovered was that because Costco jointly owns a PBM known as Navitus Health Solutions, it has been able to leverage that relationship in order to avoid some of the pitfalls in negotiating its own PBM contracts which other retailers might accidentally assume in their own PBM contracting. In other words, Navitus goes through Costco's PBM contracts with vulturous PBMs like Cigna Express Scripts, United Healthcare's OptumRx and CVS Health/Aetna/Caremark line-by-line and Navitus negotiates those contracts to benefit Costco (to the extent possible; I assure you, it's an ongoing battle).
I really like the fact that Costco's Pharmacy enables consumers to check prescription prices online at https://www.costco.com/cmpp to understand what the cost will be, and Costco will gladly sell prescriptions to patients for cash if it saves them money. However, I don't generally fill my scripts at Costco Pharmacy because it's impossible for me to get in and out of Costco quickly; it's like a half-day event for me. Nevertheless, rival Best Buy's prices for a box of three Dexcom G7 sensors is currently $179.99, while Costco's prices for the same box of three Dexcom G7 sensors is $177.05. That's remarkably close (a difference of just $2.94).
Health Insurance Company Games to Line Their Own Pockets at the Patients' Expense
Most Americans don't even bother shopping around for CGM prices because they rely on third-party payers to assume a big part of the cost. But increasingly, they are the ones being ripped-off by their insurance companies, with high co-pays, cost-sharing and artificially-inflated prices on prescriptions which should be inexpensive or at least affordable. Nowhere is the "price arbitrage" more evident than on generic drugs. That means the insurance is instead transferring the costs ... to the patient, and misleading them to believe that the insurance is helping to defray the costs on their behalf when the opposite is true.
As a result, I have started to scrutinize most prescription prices closely because I have a high-deductible health care plan, so it does cost me some noteworthy cash until my deductible has been satisfied. On generic drugs, I have found that it is often (but not always) less costly for me to simply pay cash.
Since last year, Aetna/CVS Caremark began covering 37% of the cost of my CGM sensors even BEFORE my deductible has been satisfied (only on Dexcom brand CGM sensors; there is an explicit "formulary exclusion" for Abbott Freestyle Libre CGMs on my healthcare plan, although Eversense CGMs are covered not as a pharmacy benefit, but as a medical benefit on my plan). Using my insurance, my last refill of Dexcom sensors had a true retail cash price on that Dexcom G6 sensor of $169.94 for a box of three sensors. But manufacturer coupon programs from Abbott mean that I can actually switch to Libre 3 and save myself some money. Catch my coverage of that at https://blog.sstrumello.com/2023/12/abbott-gets-real-about-formulary.html for more on that. I am inclined to switch but my spouse disliked Libre's hypoglycemia alarms finding them very difficult to silence.
On February 4, 2024, I was charged $123.62 for a box of three Dexcom G6 sensors at CVS using my Aetna insurance because insurance assumed a little over a third of the cost. That worked out to a cost per day of wearing it of $4.12 if I use my insurance to buy Dexcom. But that's not actually the best price I can get. Last year, I actually paid $3.88 per day before my deductible was satisfied. And, Dexcom offers a $200/month coupon which I could use instead. That means CVS has raised the cost they're charging patients for the sensors. One issue which bothers me is I am oddly never charged the same price twice when I fill my prescription for Dexcom sensors, so I'll have to see what the price will be this month. But, as I have previously written, use of manufacturer coupons to defray the cost might enable patients to get a better deal by disintermediating their insurance from the transaction.
As I have outlined in several previous posts (see https://blog.sstrumello.com/2023/12/abbott-gets-real-about-formulary.html AND https://blog.sstrumello.com/2024/01/consider-bypassing-your-health.html for two examples), the math indicates that it may actually be cheaper for me to use a manufacturer coupon on Abbott Freestyle Libre 3 than to use my insurance for Dexcom, which would enable me as a patient to switch to Abbott's Freestyle Libre 3 CGM device. The only reason CVS Caremark started covering 37% of the cost of CGMs was to ensure that manufacturer legally-exempted rebate kickbacks from Dexcom will continue flowing to directly to Caremark. Still, once my deductible is satisfied, my insurance covers Dexcom at 100%, hence the hassle of switching back-and-forth might also be an impediment.
But I did the math, and because Abbott Freestyle Libre 3 sensors can be worn for 14 days compared to only 10 days wear on Dexcom sensors, with a coupon from Abbott, my cost per day of wearing a Libre 2 CGM sensor would be just $2.68 per day compared to roughly $4.12/day using insurance to get Dexcom G6.
I haven't yet switched, but if I can persuade my spouse (whom I share CGM readings with) that is the right decision, I may do so. Mathematically, it is indeed a better deal. And, you must disregard the myth about how paying artificially inflated prices helps you satisfy your deductible. I have done the math on that, too, and found it is better to pay what costs ME the least out-of-pocket.
But what about the application of manufacturer coupons at Best Buy Health?
As noted, both Dexcom offers a manufacturer coupon (available on its website at https://www.dexcom.com/en-us/savings-center-cgm-without-insurance and they are also distributed on GoodRx) off for an amount up to $200/month as long as the purchase is paid in cash and does not involve a third-party payer such as insurance or Medicare/Medicaid. Rival Abbott also offers manufacturer coupons applicable to Freestyle Libre sensors and I liked the Libre 3.
Best Buy Health's telephone representative did not have an immediate answer on whether it will accept manufacturer coupons, but did tell me they would get back to me in about a week since the question had to be answered by a manager who could find out. But I know that Costco Pharmacy WILL accept my manufacturer coupons, AND I previously filled a script for Abbott Freestyle Libre 3 at Costco Pharmacy.
In the end, patients' jobs are to do the complicated cost-benefit analysis to understand what their out-of-pocket costs for CGM sensors will be from various retailers and whether insurance or cash-and-manufacturer coupons will benefit them most. Do not assume insurance is your best deal. According to academic research from University of Southern California, about one-quarter of the time, patients will find it cheaper to just pay cash and not use their insurance. Let the buyer beware!
No comments:
Post a Comment