Longer Post Office Delays, High Temperatures, & Forced Mail-order Are A Deadly Combination

This week, a third-grader conducted an experiment revealing the high temperatures inside of her mailbox. She sat beside her mother, a pharmacist, warning patients of the dangers of leaving medications in such conditions. Her study revealed that her mailbox reached 118 degrees in about an hour.

If a third-grader can warn patients and caregivers like me about the risk, why aren't the insurance companies and their affiliated mail-order pharmacies? Studies have shown that mailboxes and trucks can reach temperatures of up to 150 degrees. Most trucks and warehouses that the majority of medications are stored are not air-conditioned. All prescription drugs are temperature-sensitive at some point. Most medications are not required to be tested beyond 104 degrees.

A small percentage of medications are shipped using ice packs that can give a false sense of security when medications are shipped from several states away in vastly different climate ranges. Patients have received frozen ineffective insulin after being forced to mail-order. A higher number of ice packs may make sense in a hot area in Arizona, but in Michigan, this can result in frozen medications. Last week, a mother reported receiving ineffective insulin shipped from Texas to Colorado. She believed that unsafe temperature exposure during shipping might have been the reason. As she requested a new refill from a retail pharmacy amid a pandemic, one pharmacist suggested that she should take her son to the emergency room to obtain a new prescription for insulin.

Medications mostly shipped in only bags can lose potency, become toxic, and break down when left in high heat. Sadly, the FDA does not regulate mail-order pharmacy. The State Boards of Pharmacy, whose members often have affiliations with mail-order pharmacies, refuse. Mail-order pharmacy accreditation organizations such as URAC and VIPPS also fail to ensure proper storage of medications during shipping. However, the integrity of medicines should be one of the most highly required quality performance measurements.

Due to the failure to regulate mail-order pharmacies properly, patients’ lives are at greater risk due to the recent issues with delays with the United States Postal Service (USPS). Upon consistently researching the current problems that patients have with mail-order pharmacy, I am profoundly concerned about a new, rapid increase of patients complaining of medications being delayed for weeks by USPS.

The reasons for the USPS delays vary and include:

Recent changes in administration and the new Postal Service Chief is making drastic cost-cutting measures, including reducing overtime for postal workers.
The increasing number of consumers shopping online is resulting in more packages to be delivered.
Some workers have stated that packages containing consumer goods are taking priority over other packages.
In some areas, there is an increase in postal workers calling out sick with Covid-19.

The links to some articles are at the end of this update. Sadly, any resolution appears distant.

Although medications should take priority, it is not required and isn't the standard practice. Most delivery workers are unaware that the packages that they are transporting are delicate life-saving medications. Often, all packages are prioritized based upon the shipping class, not by the content. Most medicines are not sent by Express Mail.

When delays occur, and patients are without meds, the delivery service and mail-order pharmacy will often blame each other. Due to the current issues with USPS, forced mail-order pharmacy, and loose regulation, the lives of patients and the integrity of medications are at a heightened risk. The mail-order pharmacy and the delivery service faces no penalties for threatening human lives due to the lack of regulation as patients are not provided with an option to protect their life-saving medications from the temperature extremes as mail-order pharmacy is the only option of coverage for life-saving medications.

Although I support patient's choice in pharmacy, the safest way for patients to have prescription drugs delivered is through temperature-controlled vehicles. Many local independent pharmacies often provide this service for free. This also allows for patients to develop long-lasting critical relationships. Sadly, the insurance companies often force patients to their own affiliated mail-order pharmacy by forcing patients to pay unreasonable copays or 100% of the cost.

Many of the following quotes are from articles from across our nation in the past week:

“Many of my constituents have rightly contacted my office to express frustration and concern about ongoing mail delivery delays, some of whom have not received their medications…”

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"I need my medicine and I haven't been able to get my medicine in over weeks and I'm like, 'Well, wait a minute, something's wrong.”

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Chicago: He said problems with USPS deliveries have been an issue around Chicago for a couple of years, but during the pandemic his office has gotten more complaints.

He said he is most concerned about seniors getting medications.

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Portland Maine: According to letter carriers in Portland, it's medications, paychecks, and other first-class mail that's getting left in the office overnight. They say Amazon packages are taking priority at the order of the postmaster and other supervisors in the building.

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Baton Rouge, LA “Issues with USPS are affecting residents getting their medications”

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