— Academic medical centers have a duty to intervene
by Jacob Murphy May 4, 2025 • 4 min read
Murphy is a rising internal medicine intern.
"CA$H 4 SEALED & UNEXPIRED DIABETIC TEST STRIPS -- CALL NOW."
This message, printed in black on a neon yellow poster board, hangs just outside the $1.1 billion Charlotte R. Bloomberg Children's Center at Johns Hopkins Hospital. The sign represents a peculiar offshoot of American healthcare: the diabetic supplies gray market. Here, blood glucose test strips are exchanged within an informal network.
This market operates through handwritten signs and websites like QuickCash4TestStrips.com, often flourishing in areas with high rates of poverty and uninsured patients. How does it work? Insured patients obtain excess test strips at little personal cost through insurance, then sell them to reseller companies. These companies profit by selling the strips below original retail prices, which far exceed manufacturing costs, to uninsured individuals. And, surprisingly, this is all legal. As one company owner candidly admitted, "I'm taking advantage, as are my peers, of a loophole."
Diabetes costs have steadily risen to thousands of dollars annually for individuals. These expenses can be even higher for the 1.5 million diabetic Americans without health insurance, especially if they experience diabetes-related complications. Without proper monitoring, these individuals face life-threatening risks of ketoacidosis, hypoglycemia, and long-term complications including vision loss, kidney failure, and amputations. In the end, they're left with a tough choice: turn to an unregulated "gray" market or potentially face major health complications and financial consequences.
"I most likely would have ended up hospitalized with ketoacidosis," admits one customer who turned to the underground exchange. Unfortunately, recipients often must resort to compromised supplies, and they report shipping problems or malfunctioning equipment.
So, does this unregulated market provide a valuable lifeline or a dangerous compromise? And do academic medical centers have an obligation to intervene in these exchanges thriving in their backyards?
Can Academic Medical Centers Address This Crisis?
I think yes -- academic medical centers do have a responsibility to intervene. They should establish formal redistribution programs that incentivize donations of excess diabetic supplies. These programs would provide safer alternatives to unregulated gray market exchanges, leveraging institutional scale to deliver essential supplies at minimal or no cost to those most in need.
Incentives to donors could include copay waivers for downstream care, free diabetes check-ups such as eye and foot exams, or connections to food assistance programs. Conditional cash transfers could also serve as effective motivators, particularly for the lowest-income donors. Additionally, centers could help patients transition from test strips to continuous glucose monitors. While health centers may have to subsidize the cost for uninsured patients, it would be a more convenient and effective method of monitoring blood glucose that would likely save money and improve health outcomes over time.
Many patients keep surplus supplies "just in case," and research suggests people won't donate if doing so may pose a risk to their own health (in the case that they need the extra supplies). Donors could thus receive priority access to supplies if needed in the future, creating a safety net that encourages donations without compromising health.
What Are the Benefits of Formal Redistribution Programs?
For recipients, access to glucose monitoring supplies can prevent hospitalizations, which is significant considering that up to one in five of all hospital inpatient days nationwide are directly related to diabetes. Emergency department visits for diabetes-related issues have risen sharply among urban and uninsured groups. By targeting these high-risk populations, academic medical centers could support communities where supplies are most needed.
Critics might question whether medical centers can afford such programs. But hospitals already pay millions for preventable diabetes complications: the median cost of a diabetic ketoacidosis hospitalization is nearly $30,000, amounting to approximately $5 billion annually. In fact, there's already a model for success. SafeNetRx, an Iowa nonprofit, collects, inspects, and distributes unused medicines to patients who couldn't otherwise afford them, serving over 150,000 people to date. Academic medical centers can build on this model by leveraging their community connections and diabetes education programs to implement similar initiatives with targeted incentives beyond simple altruism.
Why Must Medical Centers Take Responsibility?
"I have a poorly insured [diabetic] brother," one donor explains. "I run a surplus always out of fear of losing my job/insurance...My sister was also [diabetic] and died when she lost her job and I was not in a position to help her. Now I am -- I will help whenever, whomever when needed."
Academic medical centers shouldn't leave diabetic patients relying on home-made poster board ads, the kindness of strangers, or hoarded personal supplies. As community health leaders, they can follow established models, improve healthcare through prevention, and fulfill their mission by strengthening a fraying safety net. The towers that dominate our medical landscapes should offer more than symbolic hope, they should provide practical solutions for those falling through the cracks of our healthcare system.
Jacob Murphy is a rising internal medicine intern at Johns Hopkins Hospital in Baltimore.
