Monopoly Money

As the diabetes world departs from steamy Orlando a few last pieces of news and some thoughts.

Yesterday Abbott issued a press release which stated;

“Expanded Real-World Evidence from More than 250,000 individuals using Freestyle libre system Showed Higher Frequency Scanning is Associated with improved glucose control, decreased glucose variability and reduced incidence of both daytime and nocturnal hypoglycemia”

Now we don’t want to belabor this point but will someone please explain to us how making the patient do more work is a good thing. Would it not just be easier for Abbott to upgrade Libre so that it sends readings to a smartphone or Apple Watch. Isn’t this better than making patients buy an arm band that turns this Flash monitor into a real CGM.

Or perhaps patients will realize that hey the Dexcom G6 does all this already and more so why bother. Seriously the Libre may temporarily have a price advantage but here at the toy fair Dexcom showed why they are the undisputed leader in CGM.

Speaking of undisputed leaders Medtronic brought out the heavy artillery yesterday when at their analyst day they announced a program which basically pays the payor if any patient using the 670G experiences a diabetes related hospital event. This move is smart on many levels as it now makes Tandem and Insulet play defense. See Medtronic knows that neither competitor has a closed loop system yet nor can either afford to make such a promise even if they did.

Doing what they do best Medtronic is taking full advantage of their scale while locking up the most valuable piece of real estate in the insulin pump market, formulary. As we noted just the other day the company is facing many challenges and there appears to cracks in the armor. Also as we noted using history as guide most of these wounds have been self-inflicted and eventually corrected.

Tandem and Insulet may have more patient friendly systems with more sophisticated insulin dosing algorithms. They may work with the Dexcom sensor which as we just noted is the best CGM on the planet. But what that don’t have is a monopoly. Combined they have just 20% of the market. Think about that for just a moment, Medtronic could lose 10% share and still own 70% of the market, bummer.

The harsh reality when it comes to the insulin pump market is that Medtronic does not have to have the best toy in the toy chest. They do not have to play nice with the other kids. They own the market and will only change when they are forced to change. They will only change when it looks like someone ACTUALLY hurst that goose that lays the golden eggs. Their belief and we can’t blame them is, hey you want to take us on go for it.

This is the problem faced by not just Tandem and Insulet but every company that is getting set to enter this market. They are forced to play in Medtronic’s sandbox with rules set by Medtronic. Should they want to play outside the sandbox, go off the reservation and offer a different option the cost is prohibitive and there is no guarantee it will work. As this latest program shows the company is not shy nor afraid to use their scale to protect that goose.

As Momma Kliff used to say; “Not such a bad thing when you have a monopoly expect when you have to compete against one.”