Salt Lake City, UT—Pharmacists often have expressed concern that patients receiving mail-order prescriptions are missing out on the medication reviews and consultations provided by brick-and-mortar drugstores. Now, a study suggests the disadvantage of mail-order drugs is much greater than that.
The presentation, entitled Assessment of Non-Refrigerated Shipping Methods Used by Mail-Order Pharmacies and Exposure of Medications to Unsafe Temperatures, was presented at the American Society for Health-System Pharmacists (ASHP) Midyear Clinical Meeting and Exhibition. The study noted that mail-order prescriptions shipped in standard bubble-padded envelopes during winter and summer months spend a lot of time outside—and that can be a problem.
“If a medication is stored improperly during the mailing process, and subsequently arrives to the patient altered, either chemically or physically, then patient safety could be at risk,” said researcher Karlee Paloukos, a pharmacy student at the University of Utah.
“Patients should be warned of these risks and have the option to fill their prescriptions at a local pharmacy, where temperature storage logs are meticulously tracked to ensure the integrity of the dispensed medications, at the exact same cost.”
The issue is that most medications should be stored at room temperature, between 68- and 77-degrees Fahrenheit, and, when exposed to temperatures outside that range, they can be altered and/or lose effectiveness. “Increased regulation of mail-order pharmacies to ensure appropriate storage conditions are maintained throughout transit is paramount,” Paloukos explained.
In an effort to test whether mailed prescriptions fall outside recommended ranges in transit, Paloukos shipped 48 nonrefrigerated packages containing a temperature data logger to six locations through the U.S. Postal Service. To measure the effect of different temperature extremes, packages were shipped four times to each location in winter and four more times to each location in summer. Overall, seven out of eight shipments were included in the analysis because data from one summer mailing was excluded after it was lost due to COVID-19-related delays.
Results indicate that every shipment was exposed to temperatures outside the recommended range at some point during transit, with the percentage of time spent out of those temperatures ranging from 68% to 87% in the winter and 27% to 54% in summer.
Packages were mailed to Baltimore, MD; Chicago, IL; Tucson, AZ; Palo Alto, CA; Largo, FL; and Katy, TX, from December 2019 to February 2020 and again from June 2020 to August 2020.
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