Danger of mail order drugs, recent television report

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Looking4Answers
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Danger of mail order drugs, recent television report

Post by Looking4Answers »

A family member saw a report yesterday, but I am not sure what news outlet. Urged consumers to not order mail order drugs due to safety reasons. Mentioned the time drugs are exposed to heat in postal trucks, etc, and degradation of medicines. Recommended always using a local pharmacy. Unfortunately, many insurance companies force mail order on consumers. I am currently being forced into changing health insurance, and fear I may have few choices on this.

Did anyone see report? Has anyone objected to mail order for safety reasons?
fposte
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Re: Danger of mail order drugs, recent television report

Post by fposte »

Here is an NPR report about shipping concerns and mail order pharmacies.

How are medications shipped to local pharmacies? Are the temperature controls superior?
Momus
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Re: Danger of mail order drugs, recent television report

Post by Momus »

I keep my caffeine pills and Meclizine for boat/roller coaster ride in my car. They are expired for 2-4 yrs too. I don't care much. Works just as well as new lol. I'm a pharmacist. Do not follow me though...

You don't wanna keep sensitive drugs in high temp in extended period of time because it does affect stability, and how fast it oxidizes/expires. Toss any expired drugs. It might not work when you take it. That's what I tell the public 8-)
miamivice
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Re: Danger of mail order drugs, recent television report

Post by miamivice »

How do the medications travel from the manufacturer to the local pharmacy?
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Re: Danger of mail order drugs, recent television report

Post by stoptothink »

miamivice wrote: Fri Sep 06, 2019 9:34 am How do the medications travel from the manufacturer to the local pharmacy?
Exactly. Scare tactics because mail order drugs are hurting retail pharmacy.
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Looking4Answers
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Re: Danger of mail order drugs, recent television report

Post by Looking4Answers »

miamivice wrote: Fri Sep 06, 2019 9:34 am How do the medications travel from the manufacturer to the local pharmacy?

https://www.peoplespharmacy.com/article ... ed-trucks/
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dm200
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Re: Danger of mail order drugs, recent television report

Post by dm200 »

My wife and I use mail refills of just about all of our medications. I do have one that must be picked up in person.

The refills arrive in our mailbox very quickly - probably in the mail about two days.

I am not concerned:

1. I assume that the health plan and their mail order pharmacy believe that this is safe

2. The refills are in the mail for a short time

3. As far as I know, all of our medications seem to be working as expected.

I will, however, continue to watch the issue.
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ResearchMed
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Re: Danger of mail order drugs, recent television report

Post by ResearchMed »

This is not a "mail order" Rx issue, but does relate to the temperature issue.

For a while, DH needed special eye drops without any preservative.

So the compounding pharmacy (all commercial products had preservatives) made up a batch of teeny tiny vials, which apparently could be kept, unopened, for 1 month frozen, and 7 days chilled by not frozen.

Each month, the batch was sent cross-town by overnight FedEx, in a big box, with a couple of layers of styrofoam and a bunch of those freezer gel packs, still nicely solid/frozen.

I do sometimes worry about things (thinking here of EpiPen) that are supposed to remain in a reasonable temperature range. When we are out and about in hot weather, as one example, we don't have any way to keep that "in the range".
Worse, we are bringing it in and out of the house, etc., so the temp can be fluctuating considerably, and repeatedly.
But surely we are not alone with this "problem".

Even some "regular meds" (e.g., pills/capsules) with no emphasis on temp... if you read the insert, there is often a temperature range. So again, pills I carry in my purse, day in, day out, month after month... what about those?

They've all seemed to continue to "work", but I do worry about something especially critical, such as the EpiPen.

I'd think - and hope - that if it *was* really very sensitive to temp, there would be special warnings, and also special delivery packaging, etc.

RM
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dm200
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Re: Danger of mail order drugs, recent television report

Post by dm200 »

ResearchMed wrote: Fri Sep 06, 2019 11:25 am This is not a "mail order" Rx issue, but does relate to the temperature issue.
For a while, DH needed special eye drops without any preservative.
So the compounding pharmacy (all commercial products had preservatives) made up a batch of teeny tiny vials, which apparently could be kept, unopened, for 1 month frozen, and 7 days chilled by not frozen.
Each month, the batch was sent cross-town by overnight FedEx, in a big box, with a couple of layers of styrofoam and a bunch of those freezer gel packs, still nicely solid/frozen.
I do sometimes worry about things (thinking here of EpiPen) that are supposed to remain in a reasonable temperature range. When we are out and about in hot weather, as one example, we don't have any way to keep that "in the range".
Worse, we are bringing it in and out of the house, etc., so the temp can be fluctuating considerably, and repeatedly.
But surely we are not alone with this "problem".Even some "regular meds" (e.g., pills/capsules) with no emphasis on temp... if you read the insert, there is often a temperature range. So again, pills I carry in my purse, day in, day out, month after month... what about those?
They've all seemed to continue to "work", but I do worry about something especially critical, such as the EpiPen.
I'd think - and hope - that if it *was* really very sensitive to temp, there would be special warnings, and also special delivery packaging, etc.
RM
In this area, it gets very hot in the summer and can get very cold in the winter.

None of our medications are, at least in the short term, life and death medications. I suppose that if some medication I were prescribed would be life or death - then I would be concerned about mail delivery.
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Re: Danger of mail order drugs, recent television report

Post by foamypirate »

We gave up on mail order after they continued to screw up every refill and prescription, couldn't seem to get the refill from the doctor, even though the doctor filled out their stupid form and faxed it 5 different times, etc. This for a very critical medication. The last straw was just today, when another prescription failed to auto-ship, even though it had 2 refills. One page said "No prescriptions available," and another had the 2 refills listed. I had to manually refill. We will go to our local pharmacy 100% of the time now, cost savings be damned.
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Looking4Answers
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Re: Danger of mail order drugs, recent television report

Post by Looking4Answers »

I do know that my mother has eye drops that, after the pharmacy fills the prescription, are kept in a refrigerator until she picks them up. This is whether it is a few hours or a few days. She has a mail order pharmacy that would fill the prescription cheaper, but so far has decided to fill it locally.
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Re: Danger of mail order drugs, recent television report

Post by whodidntante »

I like this thread because there is no article that I need to pretend I read.

How do we think the drug store gets drugs? Do they come on a hot, stinky truck? And before, during, and after loading, are conditions sometimes poor?
fposte
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Re: Danger of mail order drugs, recent television report

Post by fposte »

It seems like both local pharmacies and mail order pharmacies only cool specific medications en route anyway. Looks like this might be mostly a problem with people not being available to take deliveries inside ASAP.
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Re: Danger of mail order drugs, recent television report

Post by sport »

My insurance gives me a choice of mail order, or local pharmacies. I was using mail order because it is a little less expensive. One time, I received a mail order Rx nasal spray. It was something I was using regularly and noticed that this one seemed different. It did not feel the same in my nose and had a different odor. My doctor told me not to use it. I am convinced it was damaged by heat as it has instructions to store between 59-77F. I contacted the mail order place and they offered to replace it, only if I paid a second co-pay. They said there was no recall for the drug, so they would not replace it. They gave me the phone number for the manufacturer. I called them, and they said they would replace it, if I would return the bad one to them. I agreed, but they told me they could not send it directly to me because they are not a licensed pharmacy. They offered to send it to the mail order place, to be sent to me. The mail order place refused to cooperate. The manufacturer then sent me a check for the co-pay. I returned the bad one to them, and ordered a new one from the mail order place. The was the last time I ordered any mail order medications. I would rather pay a little more than deal with that company directly. The mail order company is one of the very large prescription management companies.
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Re: Danger of mail order drugs, recent television report

Post by Spirit Rider »

Typical alarmist nonsense from NPR. Fails from the start with their poster child; "Correlation is not causation." Not to mention, the crusading mother has at best an extremely tenuous correlation.

Almost all medication storage instructions specify a 25C (77F) maximum storage temperature, because the only efficacy studies the FDA requires them to perform are one (1) year at 25C. This does not mean your medications do not have a high efficacy long after one year.

In fact, studies done by the FDA for the U.S. Army over decades has shown that the vast majority of medications still have 95% efficacy 10 years after manufacture. While this is only a duration test, other studies of a limited number of medications thought to be at risk for substantial high temperature degradation showed less degradation than thought.

The medications thought at risk are insulin, steroids, biologics and other liquid medications. These typically have recommendations to refrigerate until use. The shortest degradation period of these medications tested at high ambient temperatures was 4 weeks. They also tested at 2 - 12 months. While a few degraded < 6 months, the majority did not degrade until >= 6 months. The most surprising was Adrenaline which did not degrade even after one year of high ambient temperature.

While degradation from high temperature exposure during short-term mail order shipping and delivery is possible. I remain very skeptical it is true in the case championed by NPR. It is far more likely a mom's protective nature going overboard.
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Re: Danger of mail order drugs, recent television report

Post by ag1 »

My plan also gives a saving to use mail order. I have medicines where I carry a prescriptions on file so I can get the medicine refilled when I need it. But these guys would send the medicine with no control from me. There is no way to return medicine and no way to stop it from coming.

After a few such episodes I could not justify wasting so much medicine and cancelled the mail order plan. The small savings were just not worth the hassle

AG
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Re: Danger of mail order drugs, recent television report

Post by misterno »

It is funny people are concerned about safety of the mail order drugs but most people do not know that the vitamins you buy in Costco or Walmart are traveling with similar trucks under 100 F heat.

I once bought Omega 3 in Costco and all capsules were sticked to each other and became like a ball. I returned it because I could tell that package was sitting in a truck with 100 F degree Texas heat outside.

This is another reason why you should not buy vitamins or drugs on Amazon. Same deal same shipping style

I think CVS and Walgreens are using trucks with AC but I am not sure about that.
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Re: Danger of mail order drugs, recent television report

Post by Oldschool »

Pure propaganda!
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Re: Danger of mail order drugs, recent television report

Post by southerndoc »

The difference between mail order and shipping to the local pharmacy is that temperature controls are usually in place until the last mile of the delivery. Warehouses rarely have extremes of heat or cold. Packages loaded on a UPS truck are stored in the warehouse (the truck is in the warehouse) at most locations.

Where the heat -- and sometimes cold -- comes into play is when it's sitting in your mailbox all day long. I once had a delivery of atenolol that was brown after sitting in 100+ degree Georgia heat in a black mailbox on a sunny day. I'm sure it was >130 degrees inside the mailbox.

The keyword to mention is "adulterated" when you call for a replacement. If you say that it's been exposed to extreme heat/cold and you think it's now adulterated, most pharmacies will replace it free of charge. The FDA strictly prohibits them from dispensing an adulterated drug, and usually the FDA considers the drug as being "dispensed" by a mail order pharmacy when you take delivery of it.
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Re: Danger of mail order drugs, recent television report

Post by BolderBoy »

Kaiser has a massive mail-order pharmacy program. I get my drugs from them. They used to come with a Colorado return address; now they seem to come from California.

Never noticed any problem with the drugs working.
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Re: Danger of mail order drugs, recent television report

Post by vtMaps »

southerndoc wrote: Fri Sep 06, 2019 9:38 pm The keyword to mention is "adulterated" when you call for a replacement. If you say that it's been exposed to extreme heat/cold and you think it's now adulterated, most pharmacies will replace it free of charge. The FDA strictly prohibits them from dispensing an adulterated drug, and usually the FDA considers the drug as being "dispensed" by a mail order pharmacy when you take delivery of it.
How would temperature extremes cause adulteration? Adulteration (by definition) requires the addition of something to the drug.

--vtMaps
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Re: Danger of mail order drugs, recent television report

Post by Ependytis »

I work for a drug company.. Drug companies control the drug temperature from the time the drug is manufactured, formulated, filled, sent to a distribution center, and ultimately to the clinician. Once the clinician has it, it’s out of the hands of the drug company. However, all drugs are labeled with the temperature that they must be kept at. If you look on the drug label it will tell you. Just make sure the drug is kept with in the labeled temperature. If your prescription label does not say the temperature you can look it up online or in the instructions for use.
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Re: Danger of mail order drugs, recent television report

Post by southerndoc »

vtMaps wrote: Sun Sep 08, 2019 4:04 am
southerndoc wrote: Fri Sep 06, 2019 9:38 pm The keyword to mention is "adulterated" when you call for a replacement. If you say that it's been exposed to extreme heat/cold and you think it's now adulterated, most pharmacies will replace it free of charge. The FDA strictly prohibits them from dispensing an adulterated drug, and usually the FDA considers the drug as being "dispensed" by a mail order pharmacy when you take delivery of it.
How would temperature extremes cause adulteration? Adulteration (by definition) requires the addition of something to the drug.

--vtMaps
21 USC § 351 specifies that a drug is adulterated if it's decomposed from or held in improper storage causing it to be injurious to health. A discolored drug from improper storage can be adulterated, and pharmacies will take no chance that they've dispensed an adulterated drug as the FDA is pretty harsh on penalties.

The FDA/pharmacy definition of adulterated is not the same as chemical. Decomposed medications are adulterated in their eyes.
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Re: Danger of mail order drugs, recent television report

Post by Turbo29 »

southerndoc wrote: Sun Sep 08, 2019 11:28 am
vtMaps wrote: Sun Sep 08, 2019 4:04 am
southerndoc wrote: Fri Sep 06, 2019 9:38 pm The keyword to mention is "adulterated" when you call for a replacement. If you say that it's been exposed to extreme heat/cold and you think it's now adulterated, most pharmacies will replace it free of charge. The FDA strictly prohibits them from dispensing an adulterated drug, and usually the FDA considers the drug as being "dispensed" by a mail order pharmacy when you take delivery of it.
How would temperature extremes cause adulteration? Adulteration (by definition) requires the addition of something to the drug.

--vtMaps
21 USC § 351 specifies that a drug is adulterated if it's decomposed from or held in improper storage causing it to be injurious to health. A discolored drug from improper storage can be adulterated, and pharmacies will take no chance that they've dispensed an adulterated drug as the FDA is pretty harsh on penalties.

The FDA/pharmacy definition of adulterated is not the same as chemical. Decomposed medications are adulterated in their eyes.
Okay from the FDA monograph for a common maintenance drug:

Storage
Store at controlled room temperature, 20-25oC (68-77oF)[see USP]. Protect from moisture,
freezing and excessive heat. Dispense in a tight container.


If it sat in my mailbox all day in Arizona at 118F would I be justified in calling it "adulterated" as proper storage conditions were not met?
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dm200
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Re: Danger of mail order drugs, recent television report

Post by dm200 »

BolderBoy wrote: Sat Sep 07, 2019 10:02 pm Kaiser has a massive mail-order pharmacy program. I get my drugs from them. They used to come with a Colorado return address; now they seem to come from California.
Never noticed any problem with the drugs working.
Same here - Kaiser in Washington DC area (suburban Virginia). We order refills online for mail delivery. Kaiser mails them from a nearby Virginia suburb and almost always arrive in the mail two days after we order the refills. So, I estimate that the refills are in the mail for about 48 hours or so.

The only refill that I cannot receive by mail is one for a "controlled drug" that must be picked up in person at a Kaiser Pharmacy. I suppose (not 100% sure) that there might be some drugs that cannot be filled or refilled by mail because of temperature, etc. issues -- BUT we have not run into that with Kaiser.
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Re: Danger of mail order drugs, recent television report

Post by southerndoc »

Turbo29 wrote: Sun Sep 08, 2019 11:46 am
southerndoc wrote: Sun Sep 08, 2019 11:28 am
vtMaps wrote: Sun Sep 08, 2019 4:04 am
southerndoc wrote: Fri Sep 06, 2019 9:38 pm The keyword to mention is "adulterated" when you call for a replacement. If you say that it's been exposed to extreme heat/cold and you think it's now adulterated, most pharmacies will replace it free of charge. The FDA strictly prohibits them from dispensing an adulterated drug, and usually the FDA considers the drug as being "dispensed" by a mail order pharmacy when you take delivery of it.
How would temperature extremes cause adulteration? Adulteration (by definition) requires the addition of something to the drug.

--vtMaps
21 USC § 351 specifies that a drug is adulterated if it's decomposed from or held in improper storage causing it to be injurious to health. A discolored drug from improper storage can be adulterated, and pharmacies will take no chance that they've dispensed an adulterated drug as the FDA is pretty harsh on penalties.

The FDA/pharmacy definition of adulterated is not the same as chemical. Decomposed medications are adulterated in their eyes.
Okay from the FDA monograph for a common maintenance drug:

Storage
Store at controlled room temperature, 20-25oC (68-77oF)[see USP]. Protect from moisture,
freezing and excessive heat. Dispense in a tight container.


If it sat in my mailbox all day in Arizona at 118F would I be justified in calling it "adulterated" as proper storage conditions were not met?
Yes. We deal with this issue for medications left on the ambulance. They must be destroyed if they've been outside their recommended temperature range for >15 minutes.
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Re: Danger of mail order drugs, recent television report

Post by criticalmass »

Looking4Answers wrote: Fri Sep 06, 2019 9:24 am A family member saw a report yesterday, but I am not sure what news outlet. Urged consumers to not order mail order drugs due to safety reasons. Mentioned the time drugs are exposed to heat in postal trucks, etc, and degradation of medicines. Recommended always using a local pharmacy. Unfortunately, many insurance companies force mail order on consumers. I am currently being forced into changing health insurance, and fear I may have few choices on this.

Did anyone see report? Has anyone objected to mail order for safety reasons?
Sweeps weeks came early this fall! Usually you don't get this special reporting until later in the season.
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