Mailboxes Are Not Made For Storing Medications

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As I reflect on the past four years, it is clear that change has not occurred at a satisfactory pace. Once again, we find ourselves in the midst of another scorching summer, where patients are forced to insurance owned mail order pharmacies and medications are being delivered to the hottest mailboxes across our nation without any warning about the risk of loss of potency or harmful degradation that could create entirely new substances. The alarming truth is that these medications can even break down and become harmful without exhibiting any noticeable changes in appearance or color. The FDA and State Boards of Pharmacy fail to regulate the temperatures of mail order pharmacies.

This unethical practice is nothing short of a nightmare for the patients who have to endure it or patients like my son who were harmed. When patients ask mail order pharmacists about the safety of their medications after being stored in a bag and left in a trunk reaching temperatures between 120 and 170 degrees Fahrenheit, they are often wrongfully reassured that "it should be fine." That's simply a fraudulent claim or a lie. Patients should be told the truth about the risks.

I want to warn patients today, revealing the unfortunate truth that pharmacists are sometimes instructed to deceive you by assuring you that "it should be alright." In reality, it's anyone's best guess, as most medications are not tested under such extreme temperature conditions. While some medications may undergo testing up to 120 degrees, it does not imply that they should be stored at that temperature. It's accelerated testing over a shorter range of time that has a purpose of testing at these levels is to ensure that medications remain stable until their expiration dates. If tested at even higher temperatures, they are not tested to determine every chemical reaction that could produce many harmful substances that can be created.

When questioning mail order pharmacies about temperature-related concerns, it is crucial to demand the exact temperature limits specified by the drug manufacturers for safe storage. Every room-temperature medication shipped in a bag has its own stability, even though most room-temperature medications are stored in only a bag. Unfortunately, many drug manufacturers refuse to provide this temperature stability information even to state pharmacy boards during investigations or when regulations are being considered. Why is that? Drug manufacturers are aware that medications can deteriorate in some way under such high temperatures, and they wish to avoid liability. Most drug manufacturers will stand by the temperature storage guidelines on the label that mail order pharmacies are ignoring.

Fortunately, some compassionate pharmacists are willing to contact drug manufacturers for our organization to determine the safety of medications exposed to high temperatures. However, a problem arises when patients question mail order pharmacies about the extreme temperatures medications may have been subjected to: they cannot provide the exact temperature within the hot truck or mailbox. Without this crucial information, it is impossible for them to accurately determine whether your medication remains safe, regardless of their assurances. These mail order pharmacies lack sensors or temperature-tracking devices in their packaging or trucks. Mail order pharmacies most commonly use the outside temperatures when the inside of vehicles and mailboxes can be 20-40 degrees hotter than the outside air.

It is truly disheartening and bordering on criminal to inform so many patients that the only way to receive coverage for their medications, including life-saving medications for children, is to subject them to these hazardous conditions. This is nothing short of fraud, waste, and abuse.

The time has come to ensure proper and safe storage of medications throughout the entire supply chain. Once we obtain regulation, we will see a boom in innovation to protect medications through the supply chain. Currently, the most significant risk lies in the mailbox or on porches directly exposed to the scorching summer heat. Thanks to our advocacy efforts, states such as Oklahoma, Texas, Missouri, and Arizona are now discussing these critical issues. If you would like to contribute, you can

1. Share your personal story [email protected]

2. Make a donation to support our advocacy

3. Join us in taking action.

We support choice if adult patients understand and want to take the risk. As parents, forcing this upon our children is unethical and the worst form of abuse. Temperatures are just one of many issues with forced mail order pharmacies. Mail order pharmacy shouldn't be incentivized financially and no one should be left with mail order as the only affordable coverage option.

Thank you for your support,

Loretta Boesing, Patient Advocate