Disrupting complex systems, continuous glucose monitoring and a happy ending

Disrupting complex systems, continuous glucose monitoring and a happy ending

More good things for more people is good for business

Last week I used a Dexcom G7 CGM (continuous glucose monitoring) system. A friend had an extra and gave it to me. And, for reference, I don’t have any kind of glucose-related medical anything; I just like science. And my mind was blown. Having real-time, actionable insight into what my body was doing, and how I can immediately change things to feel better, was incredibly compelling. So I called my doctor’s office from the floor at Mobile World Congress in Barcelona, and asked them to put in the prescription at my local pharmacy in Fayetteville, Arkansas. Easy. 

Well…maybe not so easy. A staff member at my doctor’s office told me I’d likely be quoted a really high price, and if I wanted to price shop with much larger pharmacies, Walgreens and Walmart, they’d be happy to facilitate. And because I don’t have a pressing medical need for these devices, my insurance wouldn’t cover anything. Maybe try to see what coupon codes designed for uninsured individuals may be available, they told me. According to their Dexcom rep, they said, look for a discounted price in the $180 to $190 range. Now for the numbers, rounded for expediency. 

My local pharmacy quoted me $577 for a one-month supply, three of the Dexcom G7 CGMs. They don’t work with discounters (more on that later) but had an in-house program that would reduce the payment to $548. They also source their units from AmerisourceBergen, now called Cencora, a $200 billion “leading global pharmaceutical solutions organization centered on improving the lives of people and animals around the world.” 

Smashcut to Walgreens. 

The out-the-door cash price for a one-month supply was $455. But they could apply a coupon from FamilyWize to bring the price down to $404. For-profit FamilyWize “negotiates fair drug prices directly with major pharmacies like CVS, Walmart and Walgreens. We pass the savings onto our members, free of charge.” Walgreens also sources these devices from Cencora. 

Smashcut to Walmart 

The out-the-door cash price was $457, but the pharmacy tech said she’d try to apply a GoodRx coupon code; that brought the price down to $188--right in the range the Dexcom rep quoted my doctor. Sold! GoodRx “believe[s] everyone deserves affordable and convenient healthcare. Our mission is to build better ways for people to find the right care at the best price.” Walmart sources their Dexcom units from McKesson, another $200-billion-plus pharmaceutical distributor. 

So the coupon codes. A quick Google search will show you that GoodRx has gotten in hot water for selling user information to advertisers. They had to pay the FTC a $1.5 million fine for some issues around all of that. FamilyWize has a privacy policy that I didn’t read except for this part under the heading “Generally.” So generally, they don’t “sell, share, rent or trade the information we have collected about you.” Then, further down, you see that “you may be presented with an opportunity to provide” your data “in order to receive information and/or marketing offers directly from parties unrelated to us.” Yada, yada, yada. It’s all out there to read. 

According to the World Health Organization, 422 million people have diabetes, and they mostly live in low-and middle-income countries. There are about 1.5 million deaths every year attributed to diabetes. I know some. I bet you do too. And the numbers keep going up. 

Plenty has been written by people smarter than me about how healthcare is broken, how it’s intentionally inaccessible, how it’s been rigged to help intermediaries make money, and so on. Whether you believe that or not, up to you; doesn’t change the number of people dead or dying. 

What we have with the Dexcom G7 CGM System is an excellent product that needs to be in more peoples’ hands, and fast. Think of what would happen if millions of at-risk people could see what is happening in their bodies and change it. Think of what that would mean in terms of the health of populations, the reduction of cost to nations and companies who don’t have to treat people for diabetes because they avoided getting diabetes. Think of what it would mean for families dealing with the slow decline of loved ones. Think of what it would mean for the people who aren’t six-feet in the ground. 

When systems are broken, you don’t just say, “Oh well, that’s how it’s always been done. Business as usual. You just have to work the system.” That’s not what I say. I say we need to change the system. Break it apart and sell the pieces. Inserting friction into systems when that friction doesn’t need to be there is counterproductive and, in some cases, morally wrong. Accepting something because it’s the status quo is lazy. When you encounter a door that doesn’t need to be there in the first place, blow it off the hinges and keep on going. 

Everything I learned about who buys what from who and how you can get it discounted and how…That’s friction. Get rid of it. And the GoodRx discount code I used? Wasn’t mine. Not my data. It was input at the point of sale by a tuned-in pharmacy tech. That’s someone who knows the system, knows where the friction is, and blows that door that didn’t need to be there off the hinges like it’s second nature.  

I have a lot of abstract and specific thoughts about systems. But it’s all the same. Get rid of friction so that more people can live better lives faster—you just disrupted the system and made it better. I acknowledge that companies exist and the dogs have to eat. But there’s a better way, and whatever company you work for and whatever you do, find that way. More good products made available to more people faster is what growth is all about--personal growth, growth as a species, and business growth. This stuff is hard but it’s not that hard. No need to make it harder. 

And twist ending, folks. Today (March 5) Dexcom disrupted a system. The FDA approved the company’s new Stelo product for over the counter sale, no prescription required. From Dexcom’s description: “The Stelo Glucose Biosensor System may also help the user better understand how lifestyle and behavior modification, including diet and exercise, impact glucose excursion.” That’s me, that’s a lot of you all, and a lot of other people too. And that’s good. Coming later this year at a "competitive price," I hear.

Well done, Dexcom. People should take notes. 

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