My son, received a life saving liver transplant at the age of 2. His life depends on the potency and effectiveness of chemotherapy/immune suppression medications. In the past mail order delivered his liquid oral medications in nothing but a plastic envelope on a 102 degree day on a hot enclosed not temperature controlled UPS truck. Shortly after, he went into liver rejection which could have resulted in complete liver failure or death. I speculated that the medication could have been too weak after the delivery of medications in high heat. I vowed to never again risk his life with mail order pharmacy.
Recently, we were mandated/forced to only use mail order pharmacy in order to receive coverage for his life saving medications. Hesitant, I begged for an ice pack. The package arrived on an about 90 degree day again without an ice pack. His labs elevated again afterwards. My son wants to know, “Why would they do that?”
I contacted the manufacturer, who completes all of the testing for my son drugs who stated that both of my son’s medications should be discarded and considered less potent once stored above 86 degrees as higher temperatures and freezing could result in lower potency. I also found out that the liquid medication that the youngest children take are the most harmed by the mishandling of medications outside of the manufactures temperature storage guidelines. Our youngest of children’s lives are being threatened.
I contacted the mail order pharmacy who refused to take replace or take back the medication. They said the law & USP Pharmacopoeia allows them to ship up to 104 degrees, although the manufacturer states it is not proven safe at these temperatures.
I contacted the FDA, who states that the mail order pharmacy should be using the manufacturer’s guidelines that have been proven safe. Not the reference range by USP that has not tested my son’s exact medication. However since the mail order pharmacies are regulated loosley by the State Board of Pharmacy, not the FDA there was nothing that the FDA could do.
I spoke with a UPS driver. He states temperatures on his truck are far above 104 degrees on a 90 degree day. He is mandated to keep his door closed unless getting a package. He states it gets so hot on a 90 degree day that he cannot breathe when he opens the back.
I made over 30 calls to the insurance company begging for them to please let us pick my son’s medications up at the local pharmacy at which they are filled. My son’s physician wrote a note/appeal as his transplant team has stated that they have tried to voice their concerns about this issue with their pediatric/child patients and no one is listening! The insurance company still denied the doctor’s appeal for us to pick up my son’s medications in the safest way. It was not until the Media became evolved that the insurance company budged.
I felt helpless and have untied with many other pharmacist, physicians, patients, mothers and fathers, and caregivers who feel the same way. Helpless.
Mail order of prescription drugs should be a choice not the only option of coverage. Mandatory mail order programs from all plan types (INCLUDING the plans that are regulated by ERISA) needs to cease until mail order pharmacies are forced to store and monitor medications during their deliveries at the temperatures tested and proven safe by the manufacturer. I would never put my son’s medications in a hot non-temperature controlled environment, and shoudn’t be forced to only use this option in order to get coverage for his life saving medications.
Mail order pharmacies may appear to save money, but when my son ended up in the hosptial after taking medications that could have been compromised by having lower potency, the cost of the rejection was thousands of dollars. If his liver would have fully failed, the cost of his liver transplant for just 5 days (he was in the hospital for 5 weeks) was over $1,000,000. The lax regulation and oversight may save money on prescription drug plans, but may come at an increased cost to the health plan itself. Also, keep in mind the endless waste of medications that automatically are sent regardless of whether or not patients need them.
Also, people with chronic, complex conditions, should always have the option of face to face interaction with a pharmacist who knows their complex needs and medical history. Could you imagine being required to go to a different doctor every time you needed medical care for you or your family? The pharmacist and patient relationship is crucial to the successful outcome of the patient’s overall health. Taking this away is harmful to patients and be more costly to our already stressed healthcare system.
Another important fact. Mandatory mail order programs are discriminatory. It is estimated that 40% of our homeless are disabled. How is mandatory mail order fair and working for them as they may not have an address and not even know where they will be from day to day?
We need legislation to protect all patients by ending the mandatory mail order pharmacy coverage in every type of plan offered in the nation. We need your help to make mandatory mail order an option not a mandate.
Filed under: General Problems
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