POLL: OTC CPAP?

Coming from NZ where we have a public health system - taxpayer funded (so a lot of us here don't have medical insurance) - this might seem a silly question to most of you, but why don't Insurance companies cover OTC medical supplies where you have a Dr's prescription? Is it just an out for them? Do all Insurance companies have the same policy? I am inclined to think Insurance companies the world over are the same - lots of fine print to help wangle their way out of paying. Would the price of CPAP gear come down if it was available OTC?

zoocrewphoto wrote: I don't want people without insurance to struggle, but I don't want lose my coverage to make that possible either. And I don't think insurance will pay for many items that are OTC. They sure wouldn't cover a blood pressure monitor, even though my doctor told me to get one and even wrote a prescription. No such luck. They don't require a prescription, so they don't cover it. To get a good one cost me $80. I did it because I needed to, and I am working to improve my health. But it was a big purchase for me.

I see Amazon sell blood pressure monitors ranging from $10 (cheap and basic at that) and upwards, with one or 2 as high as $120. I think a CPAP/APAP machine can't be too much more complicated than an average BP unit. So you would think CPAP gear would become a lot more affordable if it was available OTC.

newsnore wrote:Coming from NZ where we have a public health system - taxpayer funded (so a lot of us here don't have medical insurance) - this might seem a silly question to most of you, but why don't Insurance companies cover OTC medical supplies where you have a Dr's prescription? Is it just an out for them? Do all Insurance companies have the same policy? I am inclined to think Insurance companies the world over are the same - lots of fine print to help wangle their way out of paying. Would the price of CPAP gear come down if it was available OTC?

I suspect it has to do with the idea that most OTC items are optional. Doctors don't prescribe something unless they think you need it, so it seems more serious. The only thing I can think of that insurance will pay for that is also OTC is a one allergy medication. BUT! You have to have a prescription and get it from the pharmacist to use that coverage. You can't buy a box from the shelf with insurance.

Oh, I thought of another. Meclizine which is motion sickness medication. I got a prescription for vertigo a couple years ago. When I went to get a refill before a vacation trip, they told me it was too soon. I would need to wait. So, I stopped at a store in the same chain, but different state about a week later. The pharmacist told me that the prescription was for 30 pills for $6 something. But if I didn't care about insurance, I could get the whole bottle of 100 pills for the same price. Um, no brainer. I'll take the 100. Also, those were chewable and faster acting. The first prescription I got was a larger pill, not chewable. I have since bought another bottle from amazon.com. I learned from the trip that it helps with my fear of heights, and that I have probably had a life long, slight difference in the message that my ears and eyes give in terms of balance, movement, and distance. I compensate, but at heights or bright sunny days, I can be slightly off. No more feeling shaky and queasy when hiking.

newsnore wrote:

zoocrewphoto wrote: I don't want people without insurance to struggle, but I don't want lose my coverage to make that possible either. And I don't think insurance will pay for many items that are OTC. They sure wouldn't cover a blood pressure monitor, even though my doctor told me to get one and even wrote a prescription. No such luck. They don't require a prescription, so they don't cover it. To get a good one cost me $80. I did it because I needed to, and I am working to improve my health. But it was a big purchase for me.

I see Amazon sell blood pressure monitors ranging from $10 (cheap and basic at that) and upwards, with one or 2 as high as $120. I think a CPAP/APAP machine can't be too much more complicated than an average BP unit. So you would think CPAP gear would become a lot more affordable if it was available OTC.

I was told to get a particular model as the model I had was not accurate enough.

I think a cpap machine is way more complicated than a blood pressure monitor. Adjustable settings, motor, humidifier, and it does a LOT more than just pumping air, checking pressure, and posting the results. A cpap machine is constantly monitoring your breathing. It keeps up with you. It adjusts when you hold your breath and then start breathing again. It can keep track of multiple types of data. An auto machine can then adjust pressure as needed.

Also, if the prices go too cheap, then the companies making them simply won't make them better. Why bother with the work to improve features and software if they can't charge more?

I voted no, not for machines but hell YES for supplies, ie: filters, hoses, masks.

I am glad the attempt has been made to keep the medical community fully in the loop to be educated during these early years of PAP for OSA. Seems that helped a bit for the science to get respect in a timely fashion. And I think that the distribution model has, up until now, needed to be especially lucrative to get the machine industry up and running to the point that it is. But I vote yes for OTC non-Rx, since I believe the time has come to put all that baggage behind us and help the largest number of people get the best sleep possible. That is the only humane and ethical thing to do at this point, now that we know what we know from the documentation of the success of PAP for OSA.

The objections raised by some here are as follows: (1) doctors need to be involved in medical therapies; (2) PAP can be dangerous for some; (3) innovation would grind to a halt; (4) some would be unable to afford machines. I will address those one at a time.

(1) Docs recommend OTC products to their patients all the time, and PAP for OSA would be no exception.
(2) PAP is not nearly as dangerous as the majority of OTC health products.
(3) Greater volume and greater competition would assure innovation, not stifle it.
(4) Greater volume and greater competition would lower prices for consumers while seriously increasing profits for manufacturers. As an idea of what can be accomplished, please note that our beloved hosts already sell a full-data machine with exhale relief, a humidifier, and an industry-standard warranty for less than $200: https://www.cpap.com/productpage/resmar ... ducts.html

The constant statements about pressure being damaging to some are ridiculous, in my opinion. Every product everywhere is always dangerous to someone, so that is no reason to make obtaining the product more difficult for those whose lives could be saved by it.

Shame on this planet for making as basic a right as the right to breathe so difficult to obtain for too many of its inhabitants. People should be able to obtain food, water, and air without having to be held hostage by food police, water police, or air police.

Let my people breathe.

jnk wrote:I am glad the attempt has been made to keep the medical community fully in the loop to be educated during these early years of PAP for OSA. Seems that helped a bit for the science to get respect in a timely fashion. And I think that the distribution model has, up until now, needed to be especially lucrative to get the machine industry up and running to the point that it is. But I vote yes for OTC non-Rx, since I believe the time has come to put all that baggage behind us and help the largest number of people get the best sleep possible. That is the only humane and ethical thing to do at this point, now that we know what we know from the documentation of the success of PAP for OSA.

The objections raised by some here are as follows: (1) doctors need to be involved in medical therapies; (2) PAP can be dangerous for some; (3) innovation would grind to a halt; (4) some would be unable to afford machines. I will address those one at a time.

(1) Docs recommend OTC products to their patients all the time, and PAP for OSA would be no exception.
(2) PAP is not nearly as dangerous as the majority of OTC health products.
(3) Greater volume and greater competition would assure innovation, not stifle it.
(4) Greater volume and greater competition would lower prices for consumers while seriously increasing profits for manufacturers. As an idea of what can be accomplished, please note that our beloved hosts already sell a full-data machine with exhale relief, a humidifier, and an industry-standard warranty for less than $200: https://www.cpap.com/productpage/resmar ... ducts.html

The constant statements about pressure being damaging to some are ridiculous, in my opinion. Every product everywhere is always dangerous to someone, so that is no reason to make obtaining the product more difficult for those whose lives could be saved by it.

Shame on this planet for making as basic a right as the right to breathe so difficult to obtain for too many of its inhabitants. People should be able to obtain food, water, and air without having to be held hostage by food police, water police, or air police.

Let my people breathe.

+1

I voted No. I believe there are a number of contra-indications for the use of an xPAP machine ... problems that can be made MUCH WORSE. I do not have actual proof of this, but it is what I have been told by people I trust.

That said, I do not think that expensive titration studies should be required. That may have made sense before xPAP machines could self-titrate, but now it just serves as a way for insurance companies to limit reimbursement, and that REALLY hurts those that don't have insurance but can't get a prescription. I think that your family doctor, who knows whether or not you have any contra-indicating issues, can decide whether or not to try xPAP.

I don't think we should need prescriptions for supplies, including masks. Only the machine, IMO.

Those that voted yes, do you feel the same way about the medications you get prescribed?

Well, I would love to see proof that XP problems can be made alot worse. Professionals keep claiming this but don't offer any citations.

Since doctors prescribe meds like candy and don't do any serious followups, they might as well be prescribed OTC. Of course, I am being facetious but their prescribing practices need big time reform.

49er

khauser wrote:I voted No. I believe there are a number of contra-indications for the use of an xPAP machine ... problems that can be made MUCH WORSE. I do not have actual proof of this, but it is what I have been told by people I trust.

That said, I do not think that expensive titration studies should be required. That may have made sense before xPAP machines could self-titrate, but now it just serves as a way for insurance companies to limit reimbursement, and that REALLY hurts those that don't have insurance but can't get a prescription. I think that your family doctor, who knows whether or not you have any contra-indicating issues, can decide whether or not to try xPAP.

I don't think we should need prescriptions for supplies, including masks. Only the machine, IMO.

Those that voted yes, do you feel the same way about the medications you get prescribed?

The contraindications (few and rare though they be) would be listed on the box, just like with anything else. (i.e., "Do not use if . . ." "Consult your doctor if . . ." "Not a treatment for . . ." etc.)

Peanuts are sold in grocery stores, even though life-threatening to some children. Discount stores sell knives and guns.

Aspirin is sold OTC even though it has some very serious contraindications. And sure, someone could take an OTC painkiller instead of getting life-threatening causes of their pain treated. But those are not reasons to require an Rx for relatively-safe-for-most-people treatments like aspirin.

Would there be some problems with PAP going mostly OTC? Yes, of course. Would those problems be worse than the present problems with the present system? I think not, not when it is factored in that sleepy people kill, not just themselves, but the people around them.

A medically-uninsured sleepy person may run head-on into your car on your way home this evening on a two-lane road--a person who had no easy way available to get a good night's sleep by allowing his sleep-breathing problem to be solved with some mildly-pressurized air.

newsnore wrote:

zoocrewphoto wrote: I don't want people without insurance to struggle, but I don't want lose my coverage to make that possible either. And I don't think insurance will pay for many items that are OTC. They sure wouldn't cover a blood pressure monitor, even though my doctor told me to get one and even wrote a prescription. No such luck. They don't require a prescription, so they don't cover it. To get a good one cost me $80. I did it because I needed to, and I am working to improve my health. But it was a big purchase for me.

I see Amazon sell blood pressure monitors ranging from $10 (cheap and basic at that) and upwards, with one or 2 as high as $120. I think a CPAP/APAP machine can't be too much more complicated than an average BP unit. So you would think CPAP gear would become a lot more affordable if it was available OTC.

I have one I bought for $100. It gets used maybe once a month to give a general picture. Its accuracy is not important, a few points too high or low are irrelevant to anyone's health. My cpap gets used on my face 8 hours a day every day. Inaccuracy means bad therapy and a higher AHI - my health depends on the quality of its construction. The two are not comparable.

jnk wrote:A medically-uninsured sleepy person may run head-on into your car on your way home this evening on a two-lane road--a person who had no easy way available to get a good night's sleep by allowing his sleep-breathing problem to be solved with some mildly-pressurized air.

I think you're over simplifying this. If this was really as easy as picking up a machine at the local discount store and slapping a mask on people wouldn't need all the help this forum provides and the one year compliance rate would be a heck of a lot higher than it currently it.

Until they start making idiot-proof machines and mask technology greatly improves to the point that mask fit and leaks are no longer an issue self-help isn't going to be the most effective option in my opinion.

A minute percentage of CPAP users ever find this forum.

Adherence rates most often quoted are decades old.

Self-help is the only kind of help available with PAP treatment for most TODAY--including the majority of the "well-insured," since their primary docs know nothing about it and their sleep docs are only involved in the diagnostic stage for most. And now that is disappearing with home testing.

Remember, the help with the day-to-day treatment is not, in the presently most-common system in the U.S., supposed to be given by docs; it is supposed to be provided by highly-trained experts at the local DME. And how's that approach working out for Joe CPAP out there with adherence issues? I personally think Joe would do better with an instruction manual in Chinglish than with the words out of the moutn of your average ding-dong DME empolyee. Just my opinion. At least the manual wouldn't have a reason to lie on purpose repeatedly for years.

For most with sleep-breathing issues, it IS an incredibly simple thing and absolutely harmless even if they don't actually have OSA, despite what the people in the biz would have you believe as justification for their job.

I can see an Rx being needed to control a substance that is likely to be abused, but I am aware of no problem with recreational use of CPAP.

I consider statements about supposed undocumented "dangers" of CPAP to be the oversimiplification doing the most damage.

As famously supposedly said by one early researcher/clinician, the only way to actually hurt someone with a CPAP machine is to hit him over the head with one.

A simplification? Maybe. But more truth than the oversimplifications of those who have been scared into submission by the present OSA-treatment cartel.

In my opinion.

Which I admit is not worth any more than anyone else's, no matter how strongly I hold it.

jnk wrote: Remember, the help with the day-to-day treatment is not, in the presently most-common system in the U.S., supposed to be given by docs; it is supposed to be provided by highly-trained experts at the local DME. And how's that approach working out for Joe CPAP out there with adherence issues? I personally think Joe would do better with an instruction manual in Chinglish than with your average DME empolyee. Just my opinion. At least the manual wouldn't have a reason to lie on purpose repeatedly for years.

F

How about a DVD with instructions demonstrated with a choice of language for subtitles? And a CD with relaxation / visualizations to help people fall asleep.

If you make one, BlackSpinner, I might buy it--IF it is rated PG or below in the U.S., that is, of course.