According to the Juvenile Diabetes Research Foundation, nearly 24 million Americans have diabetes. It's a serious lifelong condition. Many who have diabetes keep their blood sugar levels under control by taking daily shots of insulin. Wendy Roberts contacted News 4 Investigates after her mail order prescription pharmacy started sending her 90 day supplies of insulin in a box with nothing inside it to keep the insulin cool. Heat can damage insulin and make it less effective or at the very least it can reduce its shelf-life.
Roberts' insurance company contracts with mail order pharmacy, CVS Caremark. Caremark assured her that it only ships insulin unrefrigerated when forecasted temperatures along the delivery route will be between 32 and 78 degrees. Keeping track of the changing weather forecasts along the routes of thousands of shipments sounds like a complicated and difficult task. Caremark is the only one of three major mail order pharmacies, including St. Louis based Express Scripts, that ships insulin without gel-filled cold packs to keep the medicine cold. And the major manufacturers of liquid insulin told News 4 Investigates that it instructs mail order pharmacies to always store and ship insulin refrigerated, between the temperatures of 36 and 46 degrees.
Caremark appears to be out on an island with its shipping practices and it's widely assumed that the company is doing this to save money. Although Caremark won't confirm that and it reiterated in a statement that the safety of its patients is its top priority. But their shipping practices are causing concern and concern well beyond St. Louis. Dr. Sue Kirkman, the vice president of clinical affairs for the American Diabetes Association, told me that her organization has started getting calls and letters from other diabetics who have received unrefrigerated insulin. She said the organization plans to write about the issue in a future edition of its Diabetes Forecast Magazine and will be pushing for uniform shipping standards for all companies that ship insulin.
Where does that leave diabetics? Professor Nicole Gattas of the St. Louis College of Pharmacy recommends that diabetics get their insulin prescriptions filled at a local pharmacy, to avoid these potential problems. But that could be too expensive for some people and others might be restricted by their insurance plans, to receiving prescriptions only from a mail order pharmacy. If that's the case, Gattas recommends you ask the mail order pharmacy to send the shipments in 30 day supplies instead of 90 day quantities. If you have trouble getting the company to agree to this, she recommends that you call and ask to speak to a pharmacist to explain your concerns and your likely to have better luck getting the mail order pharmacy to understand and cooperate. Also, she pointed out that some insulin pens contain 50% more medicine than a single vial. If you have the option, getting the pen will give you more medicine for the same prescription co-payment amount.
Late development: CVS Caremark sent News 4 Investigates a statement that says it will now be sending all shipments of insulin with cold packs and has no plans to change that policy in the future.