This week, I received communication from the Missouri State Board of Pharmacy. On the 11th of January, regulations of temperatures and mail order pharmacy will be discussed. Public comments will be allowed for two minutes. Commenters will be able to attend virtually.

Many are forced to an insurance-owned mail-order pharmacy as temperatures are not regulated. Many Board members have conflicts of interest, so it will take public pressure for them to do what is right. Please support us in any way possible. Your voice is the best way to help as Express Scripts is headquartered in Missouri and has a strong influence on the Board of Pharmacy. 

The email stated, "The Board will be discussing the temperature control topic at their January 11th meeting.  The meeting will be held live in Jefferson City, MO, however, a WebEx attendance option will be available.  The Board asked staff to draft preliminary language that would address:  (1) mandatory patient notification before shipping/mailing a prescription, (2) mandatory patient communication on how to detect if medication is adulterated due to improper storage or temperature variations, and (3) a mandatory mechanism for patients to notify the pharmacy of shipment irregularities.  The draft rule language will be posted online shortly (I’ll e-mail a link once the material has been posted).

I anticipate the discussion will start around 9:30 a.m., however, we’re still working on the schedule and may need to push the time back closer to 11.  Let me know if the morning of January 11th will work for you.  This item is only scheduled for Board discussion right now, however, the Board President will usually take public comments (limited to 2 minutes)."

Here are my thoughts on the board's actions. In all I do, I think about my son and the future of pharmacy for other patients. His medication that arrived less potent was a liquid oral transplant medication. I'm certain the temperature exposure caused his med to be less potent. Regarding this rule, I ask myself if I would have been alerted that his room temperature medication shipped in a flimsy bag on a hot day was exposed to harmful temperatures and unsafe to give him. 

1. Mandatory notification before shipping. We had that. We knew it was on the way. It was 102 degrees. The trucks were so hot that on a 90-degree day, my UPS driver said he couldn't breathe in the back. The shipping notification will not prevent them from storing the medication in 120-170-degree trucks without protection. To be notified that the medication has shipped is common. This only helps to ensure that medications are brought in upon delivery. In the winter, parents and patients in the north work during the day and worry about their child's insulin sitting outside in the snow and extreme cold. The notification ignores the fact that once a medication reaches a certain temperature, chemical changes can occur and the medication will never be the same quality.
2.  The patient's communication on how to detect adulteration. Patients have received meds melting together and mail order pharmacies have told them it should still be safe, even when it's not safe. My son's liquid med did not change color. It did not look any different. Chemical changes can occur without any change in appearance. In one of the room temperature medications that were recently pulled for carcinogens when exposed to high heat, it was found that manufacturers changed the color of the med to disguise that the drug was breaking down.
3.  Notifying the pharmacy of irregularities. It sounds nice but most patients who notify the pharmacies receive no protection. No justice. When I called the mail order pharmacy for my son, Wesley, the second time they shipped meds without protection, they said to give it to him. I did and his labs elevated again after. The drug manufacturer & the FDA told me to discard it. Notifying the pharmacy will result in little protection and no justice.

I'll support these advances as they are steps forward, but so much more must be done to ensure safe temperature storage throughout the supply chain.

I'll post the link to the meeting when they do post it. The agenda will not be posted until one week prior. You can also check for updates here. If you notice the agenda posted before us, please let me know. 

In the meantime, no one should be forced to risk their lives with forced mail order pharmacy. 

Thank you for your support, 

Loretta Boesing, Patient Advocate

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Email: loretta@uniteforsafemeds.com