Publicity in The New York Times. Should TPA expand and go after Mail Order?

Jp Enlarged

March 5, 2013, 12:42 pm

Ask Well: Can Weather Affect Mail Order Drugs?

By ANAHAD O’CONNOR
Ask WellIs there any risk associated with prescriptions delivered by the U.S. Mail because of extreme heat in summer, or cold in winter? Can any medications be mail ordered across the U.S. mainland with out risk of decreased potency?Asked by Bible1 • 403 votes

Ordering prescription drugs online is increasingly popular. But the convenience of receiving drugs through the mail carries the small but additional risk that your medication may be damaged during shipping.

Most medications can be susceptible to losing some of their potency when exposed to environmental extremes, though the extent varies from one to the next, said Lee Cantrell, a professor of clinical pharmacy at the University of California, San Francisco. Some of the conditions that affect potency are heat, moisture and humidity. Freezing temperatures can be damaging as well, especially for medications that come in liquid form, like insulin.

“Direct sunlight can be problematic for medications as well,” Dr. Cantrell said. “That’s why they’re never stored in clear bottles.”

In one study inspired by patient stories about mail order asthma medications that had shown up looking degraded and in damaged packaging, researchers at the Carl Hayden Veterans Affairs Medical Center in Phoenix exposed packages of Formoterol, a commonly used asthma drug, to different conditions for four-hour periods. Some simulated temperatures inside mailboxes in the Southwest, which can climb to over 158 degrees Fahrenheit.

When the mercury reached 158 degrees or higher, the medication clumped and the capsules became distorted, and the authors noted a “significant decline” in the drug’s potency. They cautioned that people should be aware of other situations where medication can be exposed to extreme heat, “like car trunks and interiors.”

Of course, not every prescription drug ordered through the mail will end up in a sweltering mailbox or delivery truck. And in some cases, pharmacies take precautions to prevent such problems by packing sensitive medications in dry ice.

But be sure to look at the storage information for any drugs ordered through the mail. If you have concerns, contact the pharmacy or wholesaler and ask what they do to protect the integrity of the medication during shipping, said Dr. Cantrell.

12 Comments

12 Comments

  1. the truth  •  Mar 6, 2013 @6:04 pm

    We should work on the chains first. They are the destroyers of the profession. Consumers have a choice most of the time to reject mail order. Employers should take a stronger stance on health plans. Just read that CVS is cheaping out on vision and dental starting June 1st.

  2. impatient  •  Mar 6, 2013 @7:46 pm

    Well, duh! Sitting around in a metal townhouse farm mailbox in either blistering heat or freezing cold won’t help any medications I take. I hate mail order. I want to know the people – pharmacists and their staff – who fill my Rxs. Same rant, different day. Sorry to be a boring old patient, you wonderful pharmacists. Thank you for what you do, and continue to fight the good fight.

  3. Pharmaciststeve  •  Mar 7, 2013 @12:08 am

    I remember that study in fact the “significant decline” was a 50% decline in potency.

    Also if you look at nearly all meds.. the upper allowed storage limit.. is in the high 70′s to mid 80′s and lower storage limits is typically >40 F

    IMO.. all mail order packages should have a monitor of some sort that would indicate (change color) if interior temp of the package exceeded those temps.. and if the FDA required temp is exceeded .. the meds should be destroyed and replaced.

    Unfortunately, the temp storage requirements are required by the manufacturer, wholesaler and pharmacy, but once the package is “delivered”.. which means placed in the hands of some courier service ( Fedx, UPS, USPS ) the rules no longer apply.

    IMO.. this should be a FDA issue.. once again we need to level the playing field…

  4. broncofan7  •  Mar 11, 2013 @8:59 am

    Again, the focus should be on the PBM industry; they are the ones who are decreasing chain drug store margins to the point where the corporate bean counters feel compelled to manage every aspect of a LOCAL Pharmacy that should be managed LOCALLY. The PBM’s are the ones who set every pharmacies pricing and who also can directly drive traffic to their own mail order operation by mandating it’s use on maintenance medications. They also incentivize the use of their own mail order operations by offering cheaper copays to the patient versus going locally; what the employers don’t realize is that the #90 bottle of Nexium is still costing~ $600; the difference is at retail the patient pays $120 while the employer pays $480 whereas in mail order the patient pays $80 but THE EMPLOYER PAYS $520….The vast majority of posters on this website have a very myopic view on who truly is responsible for the subpar working conditions at their local chain drug store….besides mail order not offering patient counseling on the medications that they dispense during the actual sale of the medication to a patient; this article broaches a good topic regarding temperature fluctuation and it’s effects on medication potency….we get our medications shipped in the cool of night and delivered first thing in the AM before those harsh southwestern US temperatures can get up to 110 degrees plus inside of that delivery truck…additionally, how many times do we have the patient bring in a bottle from a mail order company asking us to identify the different looking generic tablet for the patient b/c the mail order has switched manufacturers?? Mail order and PBMS should be the focus of every professional Pharmacist organization until there is an adequate firewall built between them and the actual dispensing of medications…then if the chain drug stores continue to believe that the technology that they are investing in is worth cutting Pharmacy technician hours every year while at the same time expecting RPh’s to verify MORE rx’s should we refocus on the corporate bean counters…

  5. broncofan7  •  Mar 11, 2013 @9:16 am

    right on point Pharmacist Steve! Additionally these mail order operations violate many of the state pharmacy practice acts since the fed ex/ US postman is incapable of delivering patient counseling on the medications that they are delivering; We have toll free numbers and patient information sheets when we dispense medications just as the mail order operations do; however if we don’t make a verbal offer to counsel to a patient inside of our brick and mortar and it’s witnessed by an agent of the state board, then we can be fined and held accountable to the Pharmacy practice act…

  6. Pharmaciststeve  •  Mar 11, 2013 @8:04 pm

    The crux of the entire PBM existence is the Mc Carran Ferguson Act http://en.wikipedia.org/wiki/McCarran%E2%80%93Ferguson_Act
    It exempt the entire insurance industry from Sherman Antitrust.. it should have only applied to not for profit insurance companies… when they demutalized they should lose that exemption.

    That law goes and we could negotiate with them and a lot of the crap that goes on with them would become illegal.

    Recently the state of MS tried to put the PBM’s under the BOP.. the PBM’s has threatened to drain the state’s coffers defending that action..

    If they permitted this it could be argued that they are no longer a “insurance entity” and no longer covered by McCarran Ferguson Act..

    their whole business plan would be turned upside down.

  7. broncofan7  •  Mar 12, 2013 @5:46 pm

    Great information Steve! I was unaware of this exemption for PBM’s…Pharmacists really should read this website for some entertainment…http://www.pcmanet.org/…it’s the lobbying website for PBM’s….here’s a quick link to something that the PCMA opposes: transparent MAC pricing(maximum allowable cost) —-if you’re an owner you know that routinely we lose $2-3 on 4-5 RX’s a day that are MAC’d out by the PBMs–I lost $4 on generic Adderall xr 20mg –and each PBM has an “appeal process” which I always submit and it takes them 2-4 weeks to then give you an email back that the “dispute” has been reviewed but there will be NO ADJUSTMENT on the reimbursement…it’s a sham.

    http://www.uspharmacist.com/weekly_news_update/story/36383

    “PCMA takes issue with H.R. 4215, introduced earlier this year by Rep. Cathy McMorris-Rodgers (R-WA), which requires sponsors of a Medicare Part D prescription drug plan to inform pharmacies about how the plan’s “maximum allowable cost” reimbursement limits are set, to update pricing information weekly, and ensure that pharmacies are notified promptly of pricing changes.”

  8. broncofan7  •  Mar 12, 2013 @6:45 pm

    Great information Steve! I was unaware of this exemption for PBM’s…Pharmacists really should read this website for some entertainment…http://www.pcmanet.org/…it’s the lobbying website for PBM’s….here’s a quick link to something that the PCMA opposes: transparent MAC pricing(maximum allowable cost) —-if you’re an owner you know that routinely we lose $2-3 on 4-5 RX’s a day that are MAC’d out by the PBMs–I lost $4 on generic Adderall xr 20mg –and each PBM has an “appeal process” which I always submit and it takes them 2-4 weeks to then give you an email back that the “dispute” has been reviewed but there will be NO ADJUSTMENT on the reimbursement…it’s a sham.

    http://www.uspharmacist.com/weekly_news_update/story/36383

    “PCMA takes issue with H.R. 4215, introduced earlier this year by Rep. Cathy McMorris-Rodgers (R-WA), which requires sponsors of a Medicare Part D prescription drug plan to inform pharmacies about how the plan’s “maximum allowable cost” reimbursement limits are set, to update pricing information weekly, and ensure that pharmacies are notified promptly of pricing changes.”

  9. broncofan7  •  Mar 12, 2013 @6:53 pm

    http://www.pcmanet.org/2013-press-releases/mississippi-state-board-of-pharmacy-backs-down-after-pcma-threatens-lawsuit

    “Drug store LOBBY POWERGRAB…” these guys are truly full of SH*T!

    “Drugstore Lobby ‘Power Grab’ Hits Legal Roadblock

    (Washington, DC)—Facing a lawsuit alleging violations of federal law, the Mississippi Board of Pharmacy (BoP) reversed course and rescinded a proposed regulation that would have imposed unprecedented – and costly – new fiduciary mandates on pharmacy benefit managers (PBMs), the companies that employers, unions, and state agencies hire to negotiate discounts from drugstores. Most states, including Mississippi, have traditionally relied upon the State Department of Insurance – not the Board of Pharmacy – to oversee PBMs…”

  10. broncofan7  •  Mar 13, 2013 @4:03 pm

    http://drugtopics.modernmedicine.com/drug-topics/news/drug-topics/associations/oregon-pharmacists-support-pbm-reforms

    S.B. 363 would allow patients in Oregon to choose where they want to fill their prescriptions—without the risk of higher costs. Some health plans have required that patients use out-of-state mail-order pharmacies for “maintenance” prescriptions. This bill would allow them to transfer their prescriptions to community pharmacies in their state if the community pharmacies accept the same level of reimbursement as the mail-order pharmacy.

    “This legislation will help prescription drug programs work more efficiently for employers, fairly for pharmacists, and ensure more of Oregon healthcare dollars contribute to local jobs and small businesses,” said Michele Belcher, pharmacist and owner of Grants Pass Pharmacy, Grants Pass, Ore, in a prepared statement.

  11. broncofan7  •  Mar 16, 2013 @8:12 am

    This is VERY IMPORTANT FOLKS; We independents are the last domino that is keeping our profession from being completely controlled by NON PHARMACISTS….http://drugtopics.modernmedicine.com/drug-topics/news/drug-topics/latest/ncpa-supports-bill-allow-independent-pharmacies-collectively-neg

    ” “H.R. 1188 makes the contracting process more even-handed by allowing independent community pharmacies to join together to negotiate contracting terms similar to when large publicly traded chain pharmacies like Walgreens with its 7,000 stores are able to negotiate,” said NCPA CEO B. Douglas Hoey, RPh, MBA, in a press release.

    “It must be noted, however, that even Walgreens went through an extended and contentious contracting fight with a PBM that almost saw their relationship end permanently. If Walgreens, despite its clear leverage, found the contract terms so unpalatable that it would risk being excluded from a large PBM’s pharmacy network, just imagine what the owner of one or two independent community pharmacies experiences,” Hoey said. “That’s why this bill’s passage is critical.”

  12. broncofan7  •  Mar 17, 2013 @10:50 am

    here’s some ammunition for those who see chain stores as the culprit in our profession’s demise: http://www.drugchannels.net/2013/03/what-free-generic-lipitor-says-about.html FREE LIPITOR! IDIOTS…….”Pharmacies’ willingness to participate in preferred networks (as in Medicare Part D) also reflects the growing price war over generic prescriptions. In addition to competing with low cash prices to consumers, pharmacies are now also competing with lower prices to third-party payers.

    Wegmans’ loss leader strategy illustrates the industry’s race-to-the-bottom strategy and exposes the industry’s unspoken reality:

    Most consumers don’t need much assistance or advice when picking up a prescription. “

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