RemoteINR alternatives

[Joseph]

I didn't want to hijack one of the older threads on BioTel/RemoteINR so starting a new one.

I've been home testing for a few years, since pre-pandemic, and never really questioned the costs until I retired. Now that I'm on a fixed income I'm looking at the monthly "Remote INR Services" billed each month and wondering what it covers. I spoke with a rep this morning and, as I assumed, it's the costs of receiving/storing the results and transmitting them to my doctor. So my monthly payment assists with their hosting and server costs and (according to the rep) a fax to my doctor. I asked if I could still order supplies if I canceled my account and was told that I could not. I understand the business model, I just don't like it. I can track my own results and call my doctor if they're out of bounds but apparently I have to use BioTel.

I'm sure I could get something on the gray market, eBay obviously lists several devices, and I could find a supplier for strips. Unsure how my insurance company or doctor would feel, likely they would question the veracity of the results. I'm assuming there are alternatives around the world (I'm in the US so my experiences will be different than say a user in Australia) but obviously there are only so many companies in this field.

How are others performing home testing and do you use RemoteINR or some other service?

 

[Protimenow]

I've been self testing and self managing since 2009.

I'm currently using the CoaguChek as my primary device. It's the standard in the United States (and probably elsewhere globally). I bought my meters on eBay (some for as little as $29) and have had no problems with any of them. Don't let the Gray Market thing scare you -- Roche makes these meters to run accurately for many years. Each supply of strips comes with a code chip that is designed specifically to work with the strips and provide an accurate result.

The meters are made to run thousands of tests - some clinics use them and may perform 20 or more tests a day - week after week. Your weekly testing -- even with a used meter -- is no challenge to these meters.

The 'cheap' meters - (like the ones I bought for under $30) may be missing the battery cover or the strip guide, or both (done, I think, to disable surplus meters or those taken out of service (fully amortized) or retired). Roche may be able to replace the strip guide (and maybe the battery cover) if you call and ask. You can make a 'strip guide' with a used strip, and if you're careful with the meter, you may not need a back cover (or you can make one out of cardboard).

You can get your strips on eBay, or overpay elsewhere. Choose a seller with a good reputation, choose strips with an expiration date as far out as possible, and check if the seller takes returns. Don't bother buying strips in six packs - you'll pay WAY too much per strip (usually). It probably makes sense to buy 24 or 48 at a time.

Self management is easy - Pellicle and others should be able to help - and it feels good to take control of your INR management - who can be more concerned with your life than you are?

The main snag is getting your doctor to prescribe warfarin. I've convinced my doctor that I'm able to self manage. I keep a spreadsheet for each test and any dosage changes. Just telling my doctor that I self manage was enough to convince him to prescribe my warfarin. If necessary, I could have provided PROOF that I'm able to do it.

Doctor's offices, or clinics make money by reviewing your INR and applying a general formula to your dosing. My doctor didn't care about what his practice makes from this simple service. Yours may not, either.

If you're uncomfortable self managing, your doctor should be able to accept your called in INR and give you dosing advice.

Also - if you're on Medicare, I'm told that your doctor can prescribe a meter and Medicare will pay for the meter and strips. I'm on Medicare but already have my own meter, so I haven't asked about having Medicare provide it - I might one year.

Again - I wouldn't worry about buying a meter from a seller who has a favorable rating. I buy my strips from U.S. sellers (you can also get them from Greece or other countries for less money and they're probably good. It probably doesn't make financial sense to counterfeit strips, so whatever you buy are probably legit).

I wouldn't be at all surprised if others also comment to your request, but I WOULD be a bit surprised if most don't agree with me.

 

[dick0236]

How are others performing home testing and do you use RemoteINR or some other service?

Are you on Medicare yet? If you are, home testing is covered 80/20.......but you must use one of the remote INR labs. Medicare requires a third-party provider......probably a legal issue.........or a strong lobby in Wash. DC.

If you are too young for Medicare (65) you may want to look to E-bay for reasonable costs of supplies. However, your PCP or Cardio may not accept your results.......again for legal liability since they write your prescription for warfarin.

 

[pellicle]

Hi

How are others performing home testing and do you use RemoteINR or some other service?

I've been full self managing for over 12 years now. I just get my Dr to prescribe me my pills (I get 1, 3 and 5mg in bottles of 50; which is the standard size for my brand here in OzTrayLiYa) and I test weekly and write it up. Nobody else is involved.

My Dr soon ceases even asking me about my INR (because they've seen my data), heck my cardiologist (who I see about every year or two) seldom even asks (because he's seen my data from the start).

The only issue I have is when I change doctors I have to give them the little discussion of how I work, what my INR is, what its been and yadda yadda. They soon feel comfortable that "nothing is going to bite them" and just write out the pill script for me.

In Australia (same as when I lived in the EU) I don't have to go through strange channels to get my strips, I just buy them off a medical equipment supplier >because they are just medical equipment< in no way different to Blood Glucose strips are.

Imagine trying to sell a diabetic they needed some agency (middle man) to take their blood numbers and tell them what they had to do or how much insulin they should take? They'd laugh it off and walk away. Yet that's what I see over there (being bound to a middle man).

We have quite a few US based members who (since before I was even a ratsak user) have been using eBay for strips and even Coaguchek Machines.

Reach out if you want a good system of documentation I'll teach you mine (which has benefits of even assisting you with dose determination).

Best Wishes

 

[Joseph]

Well, this confirms what I should have known (and done) years ago. I only occasionally go far enough out of range that my PCP calls me. Otherwise, I'll check of course and get her thoughts but I think she will accept my self-reporting and happily refill my Warfarin scrip. Guess we'll find out, I'd rather spend the $65/month USD on something other than a few cells in a company's database. Thanks everyone!

 

[pellicle]

Hi

I'll check of course and get her thoughts but I think she will accept my self-reporting and happily refill my Warfarin scrip.

she probably will especially if you can provide some evidence to assist her faith.

I propose you copy this sheet (if you have a Google account and use Google Sheets then copy it into your own area and just work on it; otherwise download it in a format you prefer. Its pretty obvious how it works (unless you're someone who has no experience in documentation or using spreadsheets in a neat and organised way).

Next ensure that you have a weekly pill box and tell her about that and explain to her how you follow this weekly cycle:

1. test every Sunday
2. use that INR test to determine if your dose needs to change (usually it doesn't)
3. based on that INR reading enter the dose you will take for the week (which in my system starts on Sunday, and indeed many pill boxes are Sunday to Saturday) so that you can't make the mistake of missing a dose

Use this basic flowchart for step 2

Obviously the devil (of by how much do I adjust) is in the details; but many people get a feel over time. I can show you another way which is both pharmacokinetics and evidence based if you're inclined.

You'll notice that (when you copy or download that sheet) that weeks are numbers not dates, I do this because its easiest to allow people to have some flexibility and they can just enter the date in the right week row. In case you're unfamiliar with thinking of what week of the year it is this is 2023

You'll notice that I also have a -1 and a -2 (which will be the previous weeks of last year, added just to bring a bit of continuity into the graph). Same goes for 53 and 54 (some years have 53 weeks, for instance 2006, 2012, 2017 and 2023 are all 53-week years)

I strongly recommend you do not touch the first sheet of the book named "20__ - Data" but copy it and then rename it (something like 2023 - Data) and then use that.

HTH

Guess we'll find out, I'd rather spend the $65/month USD on something other than a few cells in a company's database.

 

[Joseph]

I'm a 30+ year IT professional so this all makes perfect sense and is exactly what I was envisioning; Thanks for saving me the trouble of reinventing the wheel. My INR goes through long stretches of stability and then will go sideways for no particular reason. I don't think my doctor should have any concern but I'll definitely use your spreadsheet as supporting evidence that I'm (mostly) capable.

 

[pellicle]

My INR goes through long stretches of stability and then will go sideways for no particular reason

Same here

Feel free to reach out for an extra column in that sheet (and a basic explanation of what and why) as well as another bonus. The system I put together is based on my background in biochemistry and like yourself some decades in IT and data analysis

Best wishes

 

[Timmay]

I’ve been self managing for about a year or so.

I have three (3) CoaguChek meters all purchased over eBay.

My meters have always agreed with each other. They are perfect.

I’ve done comparisons against INR checks where they draw blood. I’ve done enough veinous INR tests that I don’t trust them at all. It is highly dependent on who is handling your blood and if they’re following the protocol / procedure correctly.

Example:
Test with CoaguChek and get 2.6.
Veinous blood draw 20 minutes later. INR is 2.2.
Test with a different CoaguChek 20 minutes later after I get home using a different batch of strips. INR is still 2.6.

This has happened multiple times. I have also had a veinous INR check that has agreed with my meters. I guess on that day those people were following the protocols perfectly.

I definitely trust the CoaguChek. I trust eBay CoaguChek meters. I don’t trust blood draws for INR.

 

[Protimenow]

Meters that all agree with each other is not necessarily proof of their accuracy -- they can all be set up to give equally incorrect results.

HOWEVER - Roche has way too large an investment in this technology to deliver bad results:

Bad results could expose them to multiple lawsuits if users are injured as a direct result of dosing based on bad results.

Bad results could cause the FDA to withdraw approval of the meters (like they did with the dangerous Hemosense a few years ago).

Bad results would damage Roche's reputation -- a cost that they don't want to bear.


In the case of the CoaguChek family (XS, XS Pro, XS Plus, Vantus and the other new meter), I'm in full agreement with Timmay: I trust the XS much more than I trust the labs.

I've had lab tests as high as 7.1 -- with tests on a meter around 3.0 (I haven't referred to my spreadsheet for exact numbers). I had a doctor whose results for me AND ANOTHER PATIENT WHO WAS ALWAYS IN RANGE, with identical lab results: 5.1. The lab claimed that it rechecked the samples, and got the same result. To verify the value, I went to two different doctor's offices for testing - both results were 3.6 and 3.7, IIRC. I told the doctor and he was relieved -- the lab was wrong, not the patient.

I'm trusting my life to the CoaguChek XS (I have two XS and an XS Professional -- which has similar features to the latest Roche meter).

 

[Joseph]

Just to put a bow on this thread, I received my fancy new meter today and plan to cancel the RemoteINR plan next week. My PCP certainly had no issues and signed off without worry. I confirmed with BioTel that there are no penalties in my contract and they'll just send a mailer so I can ship the old unit back. I did verify that they do not offer an option to buy the leased equipment so back it goes.

Big thanks to everyone for their input, especially @pellicle, as this gives me complete freedom in monitoring my health.

 

[Protimenow]

Which 'fancy new meter' did you get? Did you buy it on eBay or from a supplier? If you're on Medicare, did they pay for it?

I'm glad that you're taking this into your own hands. Because you already know how to run tests, management shouldn't be much of a challenge - especially with Pellicle to help.

 

[Joseph]

I checked eBay and other sites but didn't see anything that grabbed me. I already have several expensive hobbies so didn't want to add rebuilding INR meters to the list. I'm not on Medicare so knew this would be out-of-pocket. I purchased the INRange from Reliaston since I've been using the Vantus and was comfortable with the features. I could have purchased an XS from this supplier or eBay but the INRange is a nice unit and came with 48 strips (exp 12/2024).

Unit arrived in two days and I did comparative tests this morning (with similar INR results) and it's noticeably faster than the Vantus. All-in-all, it will give me total control and save money year-over-year so definitely a recommended purchase for those on the fence.

 

[pellicle]

purchased the INRange from Reliaston since I've been using the Vantus and was comfortable with the features. I could have purchased an XS from this supplier or eBay but the INRange is a nice unit and came with 48 strips (exp 12/2024).

A good choice no you get warranty too

BTW I just looked at eBay in the US

https://www.ebay.com/itm/355156976688
I found 3 on the first page. They either work (in which case ) or they don't (in which case return for refund).

But new is totally a good choice if money isn't an issue.

 

[Joseph]

But new is totally a good choice if money isn't an issue.

Frugal but not cheap, for something mission critical I tend to "buy once, cry once" if it's in the budget.well spent if it lasts and does the job accurately for years.

 

[Protimenow]

This should last many years. Roche is apparently beginning to make strips 'specifically?' for the Vantus and InRange. Government regulations will probably require them to provide strips for the XS (and XS Pro and XS Plus) for at least a few more years, but they probably aren't compelled to make strips that will work in the new and the old meters.

As far as 'expensive' hobby is concerned, I don't know if this was in response to my mention of the meters that are missing a strip guide and battery door cover. The meters won't need to be disassembled, repaired, or recalibrated -- they'll need a strip guide (you can probably get one by calling Roche, or using a cheap workaround (a piece of a used strip), and you probably don't need a battery door. In other words, the 'expensive' hobby shouldn't cost much more than one of those meters.

However - it's good to know that you got an InRange. It should last for years. A warranty will give you extra peace of mind. Plus, IIRC, you can update the firmware on it. If I could afford one, or if Medicare starts providing these meters instead of the XS, I may actually pull the trigger and see if Medicare will pay for one. If Medicare only does the XS, I won't bother.

 

[pellicle]

Frugal but not cheap, for something mission critical I tend to "buy once, cry once" if it's in the budget.we'll spent if it lasts and does the job accurately for years.

Mine has lasted me 12 years so far.

 

[pellicle]

Roche is apparently beginning to make strips 'specifically?' for the Vantus and InRange. Government regulations will probably require them to provide strips for the XS (and XS Pro and XS Plus) for at least a few more years, but they probably aren't compelled to make strips that will work in the new and the old meters.

according to my discussions with Roche the XS can use both strips and the INRange can also use both strips. The difference is this

https://cjeastwd.blogspot.com/2023/04/pt-test-pst.html

So I rang Roche (in Australia) and spoke with a "Technical Support" officer who informed me that the two were interchangeable but there may be some differences in electronic communications. She was surprised when I said that my seller has a different price on the XS PT Test vs the XS PT Test PST.​

​

She also said to me that she thought that the difference between the names was PST was for "Patient Self Testing" ... (making me wonder what's happening over there in the Good Ole US of A)​

​

All very interesting. Given that I have the XS (and not the INRange) I'll be using the earlier (and cheaper) ones in my XS ...​

HTH

 

[LondonAndy]

Well done @Joseph . Whilst there are plenty of threads on this issue, for what it is worth in Europe generally patients are encouraged to self-test. They're not so keen on self-managing, but as others have said, provided you make small adjustments it is a case of a bit of trial-and-error and more frequent testing for a bit to make sure you've got it right.

I was lucky with the timing of my aortic valve surgery: in the same month, September 2014, the UK's National Institute of Clinical Excellence published this guidance to our NHS, demonstrating the better outcomes for patients who can do their testing more frequently than most clinics do. It also saves the health service money. So I've been testing (and managing ... shhhh!) ever since, and send in that week's result to my doctor every six weeks.

 

[Protimenow]

Mine has lasted me 12 years so far.

I had an XS that was made, I think, in 2007. When I saw some on eBay for about $29, I got one that was essentially new - the plastic was still over the display and the history only had a few tests on it (quality control testing?). My meter from 2007 was working fine - I figured that for about $30, it would be good to have a spare.

12 years of testing weekly 624 tests is probably much less than an anticoagulation clinic (sill often called a Coumadin clinic) would do in a few weeks. These meters HAVE to be robust. They have to keep running,. They have to be accurate.

With weekly testing, in theory, an XS might last decades -- A new meter that doesn't use the XS strips, or a medication that makes testing unecessary -- may come along before the XS meters stop working.