The People's Perspective on Medicine

Should You Worry About Mail-Order Prescriptions?

Have you been tempted to save money with mail-order prescriptions? Some insurers require it. Will meds lose effectiveness if they get too hot or too cold?

Many people are encouraged by their insurance company or their pharmacy benefit manager (PBM) to buy their medicines through the mail. They are told they will save money. Mail-order prescriptions are also touted as highly convenient. The insurers remind you that there is no more standing in line at the pharmacy counter. And the PBMs point out that you can easily refill your prescription online. But is there a downside to getting mail-order prescriptions? This mother says yes!

When Temperatures Exceed Allowable Range:

Q. When medications lose their potency during shipping, it can be life-threatening. This happened to my son.

Sometimes people don’t realize how unsafe it is to expose medicines to high temperatures. Others may think, as I did prior to my son ending up in transplant rejection, “They wouldn’t do it if it weren’t safe.” I was wrong.

Children’s liquid oral medications can quickly lose potency at high temperatures. Other drugs can also become less effective.

When I called the mail order specialty pharmacy about my concerns with my son’s immune-suppressing medicine being exposed to high heat, they said that they could ship my son’s medications to the local pharmacy instead of my house. I asked, “Will they be shipped in the same hot, non-temperature-controlled trucks in the same way that they ship to my doorstep?” SHE SAID YES.

Shouldn’t mail order pharmacies be required to ship medicines safely for vulnerable patients?

A. Absolutely! The guidelines for medications call for storage at room temperature (68 to 77 F). During shipping, temporary fluctuations are allowed between 59 and 86 F.

To achieve this, shippers would have to use temperature-controlled containers from the point of manufacture (even if it’s abroad) to the final customer. There are many instances where there is a breakdown in this process.

Who’s in Charge?

The FDA points out that while it issues guidelines for how medications should be shipped or stored, it doesn’t have the authority to oversee what happens in individual states. That responsibility lies with the Board of Pharmacy in each state.

This organization oversees pharmacy practices. What we have been unable to ascertain is whether Boards of Pharmacy monitor the temperature and humidity of drug shipments to pharmacies and wholesalers within their states.

The FDA’s Answer:

In response to our question about how the FDA oversees transportation of pharmaceuticals within the US, here is what we were told:

“Similar to shipping any product into the U.S., once the product is imported into the U.S., the specific transportation needs of the shipment would be determined by the firm as it is dependent upon the specifications of the particular product. The required specific storage conditions of drug products are outlined on the product’s labeling, which is intended to maintain the safety, purity, and potency of the product. It should be noted that most drug products are relatively stable at room temperature for limited periods of time, although some are temperature-sensitive. In addition, most drug manufacturers have data to support the stability of their products at somewhat elevated temperatures and other adverse conditions.”

We’re not quite sure what that means. Pharmaceuticals are “relatively stable at room temperature for limited periods of time, although some are temperature-sensitive.”

We don’t find that reassuring. What about when mail-order prescriptions are shipped in a hot truck in the summer or a cold truck in the winter? What about when mail order prescriptions are left in a mail box or on a doorstep? “Somewhat elevated temperatures and other adverse conditions” may not be as uncommon as the FDA appears to think.

So Many Opportunities for Fluctuations:

We are even more concerned about how drugs get from China to India and then to the U.S. Are they shipped in the cargo hold of an airplane where the temperature may not be controlled? Are they shipped on container ships, where it is unlikely that either temperature or humidity are maintained within the narrow limits the FDA recommends?

We have asked the FDA to share information about typical shipping practices from abroad, especially when it comes to generic drugs. To date, we have been disappointed with the lack of clarity.

Share your own experience with mail-order prescriptions in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I did not know that the regular Postal Service delivery trucks are not equipped with any kind of air conditioning. Therefore, how can anyone be sure that their medicines are not exposed to the wrong temperatures?

I received my 3 bottles of Metformin in the mail inside a plastic white envelope. When I opened the bottles, they were hot in my hand. Now I look out for the [postal carrier, so I get them inside within minutes. This is not a good way to have to take care of my medicines

One additional (and very important) reason to verify country of manufacture of your drug: I have had severe enough adverse reactions (after long-term meds were switched to an Indian source by Cigna) to end up in the emergency room. In addition to uncontrolled caliber of manufacture, add several weeks at 90 to 100 degrees temp in a ship’s hold. Y E S. The shipping was by ship, not air.

My insurance plan has pushed mail order prescriptions for years, offering 3 refills for the price of 2 (90 day supply). I tried it, and it seemed like a good savings deal at first. Pills came via USPS, in a sealed plastic bag. My insulin, which has to be refrigerated, always came via UPS, packed in a small styrofoam cooler, full of gel packs.

Insulin was always cold on arrival. Then one summer day I came home from work to find a padded envelope lying on my front porch in the hot sunlight. I opened it to find my insulin refill, with only one single gelpac to keep it cool. Needless to say, gelpac and insulin were not cold or cool, but extremely warm. They had been lying there in sun, all day. Insulin pens had a strange chemical odor. I called insurer, who scheduled a pickup of foul smelling insulin pens, and authorized a refill at the local pharmacy instead.

That was the last time I used mail away for anything. Another problem is their “autofill” program allows them to ship refills and bill your credit or debit card, up to 2 months early, and you cannot refuse the delivery, or return unwanted, unopened meds, once it’s shipped.

I found them shipping my husband’s meds (90 day supply) every other month. So he had at least a year’s meds on hand, at a cost of hundreds, at the point I notified them to stop mail order altogether. I will never use mail order refills again. If the lack of temp control doesn’t kill you, the shipping & handling costs will.

Thank you, Jackie! Your experience provided just the information I needed to stay away from mail order RX. The auto-refill billing is egregious.

I have had my doubts about mail order meds due to concerns about temperature control,etc. But, when getting meds from a local pharmacy or from one of the chain store pharmacies in your town, how can we know if their delivery system is any time/temperature better?

I get Express Scripts blood pressure medicine through the mail. They are suppose to let me know when a shipment is on its way. However, I never know the exact day they will arrive and they often sit in a hot mail box for several hours before I can get them. Interestingly enough when they first started shipping my medicine a few years ago they came in refrigerated containers. I guess it was not cost effective for them to continue this. I have worried about this because we live in Florida and it is very hot a great deal of the year. I guess the government just doesn’t care!

Overheating during shipment is a problem that many sellers ignore which is why I only buy some things during cool weather. My question is why is there a minimum temperature for solids? I often see the temperature range 68 to 77 F and I always keep them below that in the winter. I have kept some that showed that range in the refrigerator for long periods of time, well beyond their expiration date and they were fine. All the Mexican drugs I have seen just said to keep them below 30 degrees C.

How are they shipped to the pharmacies? Is there less risk? I get most of my prescriptions by mail order from my Medicare Advantage plan pharmacy. They ship it USPS 2nd Day, and it is well packaged. I never considered worrying that they might be exposed to extreme temperatures.

I have been using mail order medications for years with no apparent problems. I have one eye-drop medication that is temperature sensitive and it is always shipped in an insulated container that maintains a colder temperature no matter what the outside temperature is.

I am not surprised by the FDA’s confusing reply, and no one should be.

My concern is with the average American who buys his/her prescriptions at the pharmacy. These medications may well be left in their hot car for who knows how long? Also, there is the matter of what temperatures these meds are subjected to at home before being completely used up. I have seen meds stored on top of the refrigerator, on countertops where they are in the sun part of the time, etc. Seems to me most of us may be just as remiss as we think the shipping carriers may be when it comes to properly storing our meds at home.

There is no information on the labels of the medications that I take pertaining to how to store at home. Maybe the pharmacies need to add this information if it is as critical as this article says.

The only information on my meds is the “use by” date. This date is, for the most part, a very bogus date according to the US DoD/FDA Shelf Life Extension Program (SLEP).

“The Shelf Life Extension Program (SLEP)” is a joint program of the United States Department of Defense and the Food and Drug Administration which aims to reduce the cost to the military of maintaining stockpiles of certain pharmaceuticals by researching the expiration of drugs. Under SLEP, medications are tested for safety and stability for extended periods of time in controlled storage conditions. In many cases, medications remain effective for years past their printed expiry dates.”

Apparently, it is not just the “mail order” medications delivery protocols, but the way we store our meds at home that needs addressing. A lot of us buy our meds 3 months at a time which is most likely longer than they are in transit.

It’s pretty amazing, when they tell you not to store medications in areas exposed to extreme temperatures and/or moisture. Like the bathroom medicine cabinet. But then they get shipped at more extremes. Thanks for this article. I’ve been getting messages from my insurer to do this.

I was tempted because I’ve had trouble with a couple of medications being back-ordered and only being able to get small quantities, even after calling around to a bunch of pharmacies. I was wondering if I’d have better luck with the online place. But I’ve always had these concerns about shipping. Even supplements I tend not to buy online during certain months.

The Veterans Administration ships most prescriptions to vets via usps. I’ve retrieved them from the mailbox and, at times, they felt either very warm or cold depending on the season. One saving grace is that I get package notifications from the USPS. So I can retrieve them from the mailbox as soon as they arrive.

It appears that the VA has recently been sending shipment notifications via email.

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