Alere

[Jason]

So I have finally reached three months of anticoagulation monitoring, which was the required waiting period for my insurance company before allowing home testing. I called the doc to find out what I needed to do to get a machine and whatnot, and was put through to the INR clinic nurse. I was thinking this would be as simple as ordering up a machine and some strips and turning in the information to my insurance company, but this is not the case.

She explained that they use Alere to manage the prescription for the coagucheck XS and strips, and that they would send in the information. At that time everything will between me and Alere as far as copay, billing the insurance, etc. All that seemed alright, although different than what I had expected before the call. She then went on to tell me that I would be testing at normal frequency and no more, which should be once a month unless I get out of range. I wasn't expecting that. I thought one of the benefits of home testing was that I could check every two weeks, say, and keep on top of any changes faster without having to go to the clinic, take up their time, etc. My assumption was that the reduction in events with home testing versus INR clinics was due to more timely checks. I was also under the impression that folks on this board tested more frequently when they felt something was changing, etc.

I searched Alere and see it referenced many times here, and was wondering if any of you that use this service could help explain it to me. Am I overthinking the self-testing? I don't think it will be an issue to follow their testing protocol, but was going into this thinking that there would be more freedom involved in determining when to test. Again, any information from you that are using Alere would be appreciated!

 

[drivetopless]

Good questions. I'm trying to get a home tester, too. Can't wait to read the responses.

 

[Duff Man]

I just got my monitor and started the testing, but I'll venture a response... basically, nothing has changed except the method of testing and the way that information gets to whoever is telling you how to dose your coumadin. So if you had your test results automatically sent from the lab to the cardiologist's office, now it should probably be sent from Alere to your cardiologists office. You just call in the results on your normal/scheduled day to test.

I think that you can test more often, but the nurse lady that manages my INR isn't interested in any results except on the day she tells me to test.

I tested my INR with my new machine last week when i wasn't scheduled to test and I called the nurse instead of alere (wrong procedure for me) and she said to call back on the 14th with another test. I anticipate it will be too low on the 14th, but she seems rigid. Whatever, at least I don't need a venipuncture every time I get my INR checked now.

 

[Jason]

Thanks, Duff. Do you know whether or not you will get a 'refill' on strips if you test more often than they instruct you to?

Anyone else have experience with Alere?

 

[Duff Man]

I think I'm allowed 1 strip per week per my insurance or my prescription - or both. When you run low, you can just call in to Alere and they'll send you more. I think it actually asks you if you need supplies in the phone dialogue when you report your INR.

 

[njean]

I was testing weekly for the longest time and then I was changed to testing every two weeks, about 6 or 8 months ago. If I happen not to call in my results to Alere, I will get a call from them wondering "why" I haven't called in or if I tested. They are pretty good about that. I haven't had any problems with supplies or anything.....they'll send me the strips without me even calling for them. I always have a good supply at hand.

Good luck to you and happy testing!

Oh, I also started buying the lancets at Walmart. Forgot what I paid for a package of 100 but I know that it's cheaper then through Alere.

 

[normofthenorth]

Jason, I started out thinking that you could probably test more often than they require, but you'd have to pay for the extra strips. That still might be true, but it sounds like others are getting their extra strips covered. (Me, I've got nothing!)

 

[Protimenow]

I'm fortunate enough (I guess) to have no insurance. I was able to get meters on eBay - the ProTime and the InRatio meters seem accurate, and I've correlated their results with each other and with a lab. I trust my meters.

I have been fortunate enough, also, to get the InRatio strips fairly affordably.

I test weekly (partially because I have enough strips to allow this), and sometimes find variance from week to week. (For example, last week, I had 2.7, this week it was 3.6). Testing every two or four weeks wouldn't show these variances -- and it would be good to catch them, even if the action required is to make no changes. (I was at a trade show the last few days, and ate a lot more than usual -- perhaps this made my INR move a bit).

I've read some complaints here about some testing companies (I don't think it was Alere) charging insurance a ridiculous amount of money so they can send you meter and strips and report your INR to your MD. I don't have an MD, but I keep a spreadsheet with every result and comments about changes I may have made that might impact any change in INR. I watch my INR pretty closely and think I've got a pretty good sense of when to change doses and when to not react (based on dosing charts and information from this forum). I also enjoy the freedom of verifying that a dosage change gives the desired result after a few days (rather than waiting two weeks, as many others going to clinics have to do).

Studies have shown that self-testers are more successful at staying within range than patients who have to rely on clinics or doctors to tell them when they should test. If your insurance will pay for Alere to give you the machine, and possibly provide you with strips, it may still make sense to get some more strips so you can test more frequently -- when YOU think you may need it -- and to probably help you to confirm that you're within range. Rules of this forum say that I can't recommend going to an unapproved supplier - so I'm not making that recommendation -- however, for me, having a doctor friend (who I've shown my spreadsheet to prove that I'm keeping good track on INR and warfarin management) order supplies from a medical supply company, or getting them from 'alternative' sources (eBay) have worked for me. And it really feels good to be able to test weekly or more often, if I think it's needed to verify effects of changes in dose or other factors.

 

[normofthenorth]

+1, Protimenow! I used a similar approach during my 3 months of ACT, except my INR was lab-tested with vein punctures. But I always insisted that my PCP/GP gave me a prescription that ALLOWED me to get tested 2x/week, even though I often stayed away for 2 weeks between tests. But when I felt I needed to know where my INR stood, I didn't want to wait 1 or 2 weeks for the calendar to give me permission. As it was, I didn't get the results until the next day, but that's still way better than the next week, IMHO.

 

[Gail in Ca]

I got my Coaguchek S from Alere, but it was okayed by my HMO. The frequency of testing is up to my cardiologist. If he wants me to test once a week, as he does, then I am given enough strips to last 12 wks. I email Alere with my test results, but I get my strips from Edgepark medical supply. That's the one my HMO wants me to use. I have to get a referral each time I need more strips. If I happen to test more often due to a problem like high INR, then I might need to ask for the referral early and tell them why I needed more before they think I need them. I pay $50 for the 3 mos supply. It kind of bugs me because when I used my Protime, I got a box of 25 cuvettes (protime 5's) for the same copay. I argued with my health plan, but they said that was only because the protimes only came in a box of 25. So, I am paying twice as much to test, but I only need one drop of blood, and it is easier and better on my poor fingers. And the protime 5's are being phased out, apparently.

 

[Protimenow]

Gail:

It sounds like you're being cheated. I hate to say this, but my recent experiences should bear this out.

The CoaguChek S is ONLY authorized for health care professionals -- it is NOT promoted by Roche for home testing. (I have a letter that Roche sent me that clearly states this). Also - the CoaguChek S has been discontinued by Roche and will NO LONGER BE SUPPORTED BY ROCHE AFTER OCTOBER. Also -- Roche will stop making strips for the CoaguChek S after October, and I've seen strips offered that expire around May of 2012. Also -- the CoaguChek S is supposed to be tested for quality control every day it's in use -- I'll bet Alere didn't send you a QC tester -- and each QC test, if I'm correct, uses a strip.

I spoke to the marketing manager at ProTime a few months ago, and was assured that the ProTime is NOT being discontinued. I don't know if the five channel strips are being discontinued, but the 3 channel strips still seem to be available. ProTime will be coming out with a new meter - easier to use, less blood required, etc., but I don't know if it's been FDA approved. I don't think they'll announce it or make it available to the public until approval is granted.

I've used the ProTime (and ProTime 3), and, yes the tests use more blood (especially the 5 channel 'strip'), but I had faith in the accuracy of the ProTime results. The CoaguChek S was a pain for me to use (I had trouble getting that ONE drop, but no trouble getting much more for the ProTime (go figure)). Compared to the CoaguChek S, I actually preferred the ProTime meters.

HOWEVER -- I now have an InRatio (the original model) -- and prefer it to the ProTime. It's easy to use, the strips are still valid for a while after the expiration date, and I trust the results.

Your insurance may not have too much trouble getting money out of you for the InRatio strips -- they come in boxes of 12 or 48, so they can make you have a high copay on 12 strips.

But, again - I am amazed that Alere sent you a CoaguChek S because it is a) not designed for home testing, b) discontinued by Roche, and c) requires a QC test each day you use it.

(FWIW - I got my meter and strips on eBay)

 

[Gail in Ca]

Well I blame my mistake on the bleed. I have a Coaguchek XS, (I had to go look after reading your post)! So, it's the one I can use and it is easier and faster than the protime. Yes, it's the protime 5's that are being phased out, according to Alere. I was going to be hard nosed about the 12 vs 25 count, but I like using the XS so much better than the protime, and I play an instrument, so the tiny prick is better than that horrible slice with the protime. I was just going to say I would only use the protime until I couldn't get the cuvettes anymore, but I caved. I still could write my insurance and see if they would pay for 25 like before, but I doubt that will happen.

 

[Protimenow]

I'm really glad to see that you have the XS. The ProTime 5 strips DID take a lot of blood (I only had the 3s, and THEY seemed to want a lot of blood, too).

I don't think your insurance would cave, but you might be able to convince them to let you get the 48 strip package if you pay double what the copay would be for 25 ProTime cuvettes. They STILL should be making out a little better. (FWIW - I've seen the 25 ProTime 3 cuvettes for around $135, and 48 CoaguChek XS for as little as $160 or so, if I recall correctly).