A study published this month in the Journal of the American Medical Association (JAMA) examined the unauthorized sales by private individuals of secondhand CPAP devices. While most health insurance plans cover CPAP (learn more here about coverage for these devices), the average cost of a device for those without insurance or with a high deductible can be prohibitive .

The study examined person-to-person sales of CPAP devices at a range of geographic locations, median incomes, population densities and number of sleep clinics. They sorted through online ads for CPAP sales and even placed anonymous postings on Craigslist to solicit information from potential sellers and buyers.

What did they find?

Limited information about the device being sold

Who used the CPAP device that is being sold?

79% of ads did not have any information about who had used the device.

Others said it was a family member or the seller himself (obviously, there is no way to know for sure).

Reason for selling

82% of ads did not explain why the device was being sold.

The disclosed reasons included: previous owner did not like or use CPAP, obstructive sleep apnea was resolved, owner has newer machine, or previous user died (yikes!).

Hours of use

Almost half of the listings (49%) did not tell how many hours the device had been used.

The average like expectancy of a CPAP machine is approximately 20,000 hours or about 7-8 years of full-time use. Many insured patients will replace their machine every 5 years or so, as this is when many insurance companies will approve a new device.

Pressure settings

86% had no information about the devices current settings.

Next to hygiene, this is one of the most worrisome findings from the research. The CPAP devices are designed to be kept at the treating pressure that is established and set by a healthcare professional. It is possible to change the settings, and many people do this themselves, but it is not easy for everyone. If the new owner of the CPAP machine needs settings other than those the device is currently programmed with, he will have to figure out how to change the settings himself. Alternatively, if a device (used or new) is purchased from an equipment provider (online or in-person) a healthcare professional will input the correct settings.

The exception is APAP or auto-setting PAP (learn more about the different type of PAP devices here) which adjusts the pressure based on the how the patient is sleeping. These devices are also set, but have pressure ranges. A narrow range that works for one patient may not work for another.

Condition

53% of the listings did not include any information about the condition of the device being sold.

Buyer beware.

Price

The average price of CPAP machines sold online was $291 dollars.

This is much less that the typical cost of $600-$2,000 depending on the type of the device. Individual patient cost also varies based on insurance coverage (learn more about insurance coverage for CPAP here).

Are supplies like mask and tubing included?

61% of the listings included a used mask, but did not include any information about the mask’s age or cleaning procedures.

The concern here (beyond hygiene) is that masks and their cushions need to be replaced on a regular basis. Even though there may not be visible signs of wear, the mask straps become stretched and the seal changes. Mask cushions also need to be replaced regularly (read more about suggested supply replacement here).

Proper mask fitting is also important. Unless the buyer has another mask or knows that he/she is purchasing a mask will fit properly, the buyer may struggle with using the device. Mask issues are among the top reasons why new patients struggle to comply with CPAP therapy.

Prescription Requirements

Only 2% equipment sold online person-to-person made any mention of needing a prescription.

Of course, insurance is not involved with these cash sales; however, the FDA in the US classifies CPAP devices as Class II medical devices with possible risks and their sale requires a medical prescription. Most of these online sales are technically illegal, though quite common.

Prescriptions are also important for setting the correct pressure settings for the device. Pressure settings are usually determined during a sleep study and ordered on the prescription.

Hygiene

This is a huge concern with buying used medical equipment (and other items) online from sites like Craigslist.

What’s next?

We know that a lot of patients struggle to afford sleep apnea diagnosis and CPAP therapy. Even those with insurance (even “good” insurance like major commercial PPO plans) struggle due to high deductibles, co-pays and co-insurance.

While insurance companies are forcing prices down for the equipment providers, they are also increasing requirements for the patients. For example, Medicare pays for CPAP on a rental basis for three months and then requires proof of the patient’s usage before they will continue to pay for the rental which finally converts to a purchase. The patient must show that he is using the device at least 4 hours per night for 21 out of 30 nights in the first 90 days. If the patient is not compliant, he can start another three month trial after meeting with his physician. If he fails the second trial, he must start over with another physician visit and another sleep study. Many insurances are creating programs like Medicare.

For many patients (and their providers) compliance is a struggle. CPAP therapy isn’t easy. That’s probably why there’s a large supply of used devices available for sale on Craiglist and other selling sites.

Alternatives to purchasing a used CPAP on Craigslist

As an alternative to customer-to-customer online sales, JAMA suggests the American Sleep Apnea Association’s CPAP Assistance Program (not affiliated with JAMA) which can provide a new or used CPAP machine for $100 (compared to the mean price of $291 on Cragislist). This program accepts donations from users and manufacturers and cleans and reprograms the device based on the patient’s prescription for settings. We include additional information about their program including how to donate and request a device in this blog post.

Do you need a new CPAP machine or supplies? We’re contracted with most insurances (see a full list here).

Request CPAP appt.

Request supplies

Sources:

Peine MI, Prichard J, Kunisaki KM. Unauthorized Online Sales of Secondhand Continuous Positive Airway Pressure Devices. JAMA Intern Med. Published online August 08, 2016. doi:10.1001/jamainternmed.2016.4506.
http://www.sleepreviewmag.com/2016/08/study-raises-safety-concerns-online-sale-secondhand-cpap-devices

Other posts you may find interesting:

JAMA Study Highlights Concerns About Buying Used CPAPs on Craiglist