Does your insulin always come packed carefully in ice? Or perhaps not anymore? Medical insurers, notably CVS/Caremark, are cutting costs by skimping on packaging used to keep insulin safe during shipping. And a bunch of PWDs are mad as hell about it.
T1 writer and advocate Riva Greenberg wrote to me not long ago saying:
“What they are doing is cutting costs by not packing insulin in cold gel packs anymore if they determine the temperature is between 32 and 86 where you live when they send it. And, they make it sound like a benefit, ‘Even tough insulin manufacturers say that it is okay to store insulin for limited time periods at temperatures up to 85 degrees, CVS Caremark is taking extra care to make sure that your insulin is protected by shipping insulin with a cold gel pack if the temperature in your area is forecasted to be 78 degrees or higher.’ Yet, they used to ALWAYS ship insulin with a cold pack, so this is a lower standard of care. And what’s to say the storage facility where your insulin lay overnight is not above or under the quoted temperature they are going by?”
Riva thinks it’s an outrage, and possibly just the beginning of the kind of cost-cutting we’re going to see in healthcare that could be potentially dangerous.
Another T1 advocate named Ellen Ullman (a research associate at Close Concerns), who lives in balmy Florida, has just started a group on LinkedIn to protest CVS Caremark’s “unacceptable and unethical insulin shipping practices.” Not sure why she chose LinkedIn, but there you’ll find a growing number of discussions on the recourse for patients who want to change this policy.
According to input from Dr. William Quick (of DiabetesMonitor), “there is a precedent for the FDA taking action against drugstores for failing to keep insulin in spec.” Back in 2001, he explains, Sanofi-Aventis notified the FDA of problems resulting from Walgreens shipping insulin in non-refrigerated condition. The FDA ordered Walgreens to conduct a product recall under the title: “Temperature Abuse-product shipped unrefrigerated by recalling firm” (described here).
I’ve only had a shipment of insulin go bad once, but it took me DAYS of high blood sugars, 
discomfort and aggravation to figure it out and correct the problem. Even if you live in a temperate climate, there’s no way of knowing what your insulin goes through on its way to you. So I’d say, skimping on gel packs is just petty pinching, bound to cause more trouble than it’s worth.
So if insulin shows up on your doorstep NOT packaged with a protective gel pack, what would you do? Assume it’s OK? Call the company to protest? Watchful trial and error?
As long as the mail order service says they’re monitoring for “temperature in your area forecasted to be 78 degrees or higher,” are you concerned about this?
Bennet has written a series of blog posts on this issue at YDMV (Your Diabetes May Vary). He ran into repeated issues with shipments for both his children’s insulin supplies.
I think it’s foolish for anyone to accept mailed insulin. Under Obamacare we wont have a choice though and will have to accept mailed insulin. There wont be anyone to complain to about it either. Just one of many substandard care we can expect. We will look back to the good o’l days of private, competitive insurance. Sorry Lauren!
Even before this policy change, over the last few years, I’ve heard people say they’ve had various problems receiving shipped insulin, so I’ve never tried it. Having not trusted it before, I sure as heck don’t trust it now, and will continue to get mine at the pharmacy as I’ve been doing for the last 31 years. I know I’m paying extra for the convenience and peace of mind though.
If I did get my insulin through Caremark, which is the mail order company of my insurance plan, I’m not sure what I would do. I wouldn’t feel comfortable using the insulin, but I honestly don’t think Caremark would make the slightest effort to rectify the situation if I called and said I wasn’t paying for defective insulin and then demanded they send insulin to me shipped properly.
That the FDA took action against Walgreens for the same transgression does seem to offer some hope, but then my questions is, how do we get the FDA to put a stop to this?
Without a doubt, I find the whole thing ethically despicable.
Very interesting on Many levels.
I for one, rely on shipped insulin.
From Canada.
I do not have health insurance the costs in the US are disgustingly high.
3 for the price of one from Canada.
I have had two shipments, with a cold pack.
No issues.
Options are SO important to those with a chronic illness.
And most days I am glad I don’t have to deal with insurance companies and pharmacies in this country.
Sad.
But I do what I have to. It works.
We are all entitled to our opinions and have the Right to do what we need to.
Caremark also recently jacked me up on blood strips, claiming they were waiting for more information from my doctor (who sent them the requested information three times) before approving the prescription. Finally when the approval came through (no one could tell me the reason they had to pre-approve – type? number?) the nice woman at caremark said she’d make sure the order would be rushed to me. A week later, no strips and Caremark claimed the prescription still hadn’t been approved (except I had a letter from my insurance company now saying it had been approved.) After me yelling, reading them my letter, then retreated and changed their mind saying oh, yes! right! it has been approved, but SORRY, the paperwork hasn’t made it through the system. At which point, I lost it. I spent over four hours trying to get this sorted out and it was over a month before I got my strips. I think they put up road blocks to save money. Hoping I’ll give up? Or just prolonging the filling of the script? Because they took so long to fill this prescription, they save the month they didn’t fill it – .83 cents per strip X 10 per day X 30 days = $249.00 and I’m only one person. They suck!
Don’t tell me it will get worse if the system changes – the only way it gets worse is if we refuse to go to a single payer system, away from private insurance that are there ONLY to make money off our blood (so to speak).
And did anyone catch Bill Moyer’s last week where only private insurance groups were invited to the table to discuss the situation? No one in favor of a single payer system at the table? It is an outrage.
CVS/Caremark is based on my own experience, among pharmacy benefits managers (PBMs), the worst from so many perspectives, that I do not find this issue surprising in the least. Last year, my insurance company dumped CVS/Caremark and brought the operation in-house (Wellpoint NextRx), and the improvement was significant (although Wellpoint has just sold the PBM NextRx unit to Express Scripts, and my company is switching insurance companies again to one that uses Medco Health Solutions, but I digress …). While I never encountered problems with bad insulin while using Caremark, but I did have terrible experience with them with arbitrary coverage problems (namely Caremark decided to limit my test strip quantity based on what they called industry averages, even though my insurance company had no such quantity limitations and would have paid for them, plus inaccountability from Caremark management and difficulty resolving problems, etc.) I threatened a small claims lawsuit, but did not pursue it when my company switched insurance carriers, but those who are impacted deserve to have their voices heard on this issue!
Timely post Amy. I had a conversation with someone at Caremark within the last month because my insulin arrived without a gel pack. I don’t know why the temperature where you live should be the sole deciding factor. What if it spent two days in transit in an area where the temps were 90.
I’m a recent convert to Caremark thanks to an insurance change (not my choice). Reading these comments makes me think this will not be a change for the good. Just another fun part of life with diabetes.
Yeah! Amy
Yeah we are pals with CVS Caremark – NOT.
http://www.ydmv.net/2009/03/who-caresmark-iv.html
I wrote Lilly to see how they felt about this. They never wrote back.
Does that mean they don’t want to piss off a client like CVS?
The told another parent at CWD that their responsibility stops when they ship to the distributor. Funny they expressed all kinds of concren over the middle men when it involved Canada. Specifically Eli Lilly has very clearly stated that they are opposed to middlemen “…whose interests are making money – not helping patients.”
Here is the kicker CVS ships insulin to their stores cold. To paitents nope. Go figure.
Gee, I’m feeling a little light-headed here. I’ve never questioned my shipped insulin (via Express Scripts). It always comes with frozen rock solid ice packs (so much so that I worry abt the insulin freezing!).
I live in a city where the lines at CVS (my insurance provider’s pharmacy) are always long and the pharmacists are unprofessional and annoying. I so dislike going there (they say your name and Rx in front of the 10 pple waiting in line), that I was thrilled to move to Express Rx. It saves money and relieves me of going to CVS.
Now I’m concerned. Couple this with the brilliant video (tintsulin) about 1.5 inch air bubbles in my tubing (also something I’ve never really seen or questioned), and I’m feeling downright discouraged. No wonder we can’t always control our numbers!
I am 67 years old and have been a diabetic for 55 years. I am just thrilled with the appointment of Sonia Sotomayor. I have been a diabetic for a long time and also know much about it. I would like to be a part of this web site in some capacity.
I ordered from CVS/Caremark within the last month and discovered their new “policy”. Called up to customer service and was given the run around for an hour before they finally told me there was nothing they could do for me and this was their new policy. I’m going to the local pharmacy from now on. I refuse to spend any money on my prescriptions there when they are trying to save money and potentially endangering lives. My health is more important than extra bucks at the local pharmacy.
@T1 in Boston – Shoot! This was supposed to be a place for ENcouragement, not DIScouragement. But it’s good to be informed about stuff, no? Maybe we can affect some change for the better
I used CVS/Caremark up until last year, when my insurance switched to another provider. Before CVS came into the picture, Caremark always shipped my insulin Next Day Air and the ice packs were still semi-frozen when my package arrived. Once CVS took over they switched to Second Day Air, would ship out insulin on a Thursday or Friday so it sat in a warehouse or truck all weekend, and the gel packs were always totally melted and warm. What’s next, shipping it via 3rd class mail through the post office?
Very thoughtful insight to preservation of insulin in the right way…as per medical norms.
Never really seen the benefit in having insulin shipped – I guess I always assumed it wouldn’t be kept cold so never thought it would be a great idea. With that said, I hope that this is really just a lot of concern over nothing. It really is supposed to be ok to leave insulin out at room temperature for several days or weeks without harm, so it’s possible that shipping insulin without ice is just fine. The cost of shipping with gel packs, and the added weight/cost of shipping, could be a big contributor to health care costs – which would explain why they’ve cut it out in cases when not necessary. My particular insurance plan would only save me about $15 / month by having insulin mailed to me – not worth it considering that I waste twice that on coffee each month. I try to keep that in perspective before getting all outraged.
One thing this is not is “obamacare”… even that term is ridiculous in the extreme. The kind of fear-mongering Gianna B is spewing is just silly.
Its really great to read article. Thanks for sharing it.
T1 in Boston, I recently moved from Massachusetts to Pennsylvania for a job change and with my insurance change I went from Express Scripts to Caremark. I have been disappointed with Caremark in every way. Express Scripts shipped my order out in a Styrofoam cooler every three months with twice the amount of ice packs they needed and they shipped it overnight. I occasionally had problems with not being around to sign for it or with being charged for overnight shipping but those were taken care of with calls to customer service. I was not thrilled with them but I was always confident about my insulin. Caremark sends the insulin to me in slightly padded envelopes that are supposed to keep it cool. It just doesn’t hold up to the standards of Express Scripts in anyway. If I had a choice I’d switch back immediately. I would not worry about your insulin, if it’s like mine was it’s being handled correctly. Caremark has a lot to learn about the correct handling of insulin!
In an unofficial poll of pharmacists interviewed for a Diabetic Living story about Saving Money on Meds, the one drug the experts say they would never order by mail: insulin. The reason: The consumer can never be sure the insulin was handled at proper temperatures during shipment.
I guess I’m lucky. My Insurance will let me go to any pharmacy I want and get my Insulin, or use a mail out. I will not use mail order for my Insulin. To scary. I think if it sat outside my door till I made it home it would be boiling hot, Ilive In south Fla.
Just recently I’m giving Minimed a chance with test strips, my Ins. will let me order more from them than in the pharmacy, the cost is also astronomically less than retail. I may try Insulin delivery just to try it, But, I would ask first about keeping it cold, If they say no to packs, I would say no to them.
Maybe you could ask your endo to trade out your bad Insulin bottles, for the ones they get from the reps, they get it free from them anyway, I bet the rep would trade out the bad for good ones. Just a suggestion
Well, with encouragement from this discussion, I called Express Scripts today to speak to a pharmacist. He said: “patients who think that retail pharmacies are more properly managing & storing their insulin are deluding themselves; I worked in retail pharma for 20 years, and I can tell you, the first thing we did when we rec’d a shipment was to put the insulin bottles in the fridge – sometimes they arrived, literally, HOT!”
We talked for awhile and I came to the conclusion that there is no one best way or place to get your insulin. But it’s good to engage your pharmacist and let her or him know you’re concerned about (and want to know!) how they handle your life-supporting meds.
In the end, this pharma said that Xpress Rx’s mostly only dispense with freeze-packing when delivering to climates so cold (like 20 below Buffalo or Chicago) – that the addition of ice will result in frozen insulin. (“mostly” huh?)
Thank you, Rebecca, for your encouraging words abt Xpress Rx’s. I do get my insulin in a (very) large styrofoam cooler loaded with ice packs. While it does feel a little wasteful (how many huge styrofoam coolers can fit in your basement? or re-usable ice packs in your freezer?), I feel like I’m in pretty good hands.
Also agreed it’s not something we can afford to worry about too much. If there IS some large shipment of insulin that went bad, I’m trusting that our on-line cmty / connection to each other will enable us insulin-users to channel our outrage into advocacy.
Thank you for bringing light to this situation on your blog! We recently received a lukewarm three-month supply from Medco recently (which they did take back and reship). However, the Rep mentioned to me on the phone “Well, this is the first time we have had problems with your account.” The mix-up occurred on their end, but what if this was the second time I returned lukewarm insulin? They cited the Vet Administration Study that was done on NPH and Regular, not the fast-acting insulins. Now, we do get ONE cold pack, inserted in the middle of 10 vials of insulin, packaged in three rows. The insulin in one of the rows is never covered by the ONE icepack and there are always some vials that seem merely slightly cool. This makes me very nervous! They could easily pack the 9 vials back to back around the one icepack. Medco is now shipping two day delivery except in emergencies.
Jan – I’m just curious – do you open all the insulin boxes to feel the temp of the glass insulin bottles? That never occurred to me….
To PKing: Why is “Obamacare” a bad term to use? I think he probably would like the term. After all, socialized medicine is his #1 goal. It’s not far fetched to see the writing on the wall that some government employee will tell us that we have no choice but to have our insulin shipped from government controlled pharmacies. How exactly is that “spewing?” It’s so easy to spot statists on this blog.
I use Walgreens mail order under my Blue Cross plan. For the past two years I’ve called them when my winter time insulin order shows up when it’s freezing outside WITH an ice pack. They’ve never been able to explain why they do this. I haven’t had a problem *yet*. Does insulin crystallize when it freezes? I was going to send it back if it was frozen, but it didn’t appear to be…
Though a good idea, shipping insulin is very risky. anything artificial is not safe for a longer period of time. insulin has to be stored in particular temperature in case of shipping. but a very nice article. a very nice thought in fact to write about this topic. Keep going.
Caremark/CVS has sent my daughter’s insulin twice w/o ice packs. I even requested the ice packs AND OFFERED TO PAY FOR THEM! They told me it is their policy NOT to use ice packs EVEN IF THE CUSTOMER OFFERS TO PAY for them! Now, if they’re so concerned about saving money and someone offers to cover the cost, how does this cost them money?
I worry about the shipping causing my daughter’s insulin to lose efficiency if it warms up. I plan to contact my elected officials, and anyone else who will listen. The study Caremark CVS cites to prove they can do this does not cover my daughter’s Novolog. I questions their professional integrity and ability if they’re using this study to explain why they do this. Frankly, I believe they are jeopardizing my daughter’s health. I believe this is wrong, possibly illegal, and maybe even criminal.
No, I do not open all the bottles to see if insulin is lukewarm (even though there is only one icepack and the boxes are placed in four rows, leaving top and bottom ones 3/4 uncovered by the icepack). The insulin on the bottom still feels a bit cold. A bit. In the case of the lukewarm insulin, the whole package was lukewarm to the touch.
Sure this is a great post…insulin is important to be preserved the right way.
So I posted a comment on here earlier but now I’ve got a situation that absolutely astounds me and I thought people would want to hear. I got a shipment from Caremark right after they changed their shipping policies, it arrived without an icepack but it was still cool enough that I thought it would be ok. So I put it in the fridge and continued to use the supply of insulin I had there before starting in on the new stuff. Insulin, however, loses it’s potency slowly over time when exposed to heat. By the second or third bottle of this shipment that I got to it was clear something had gone wrong during shipment. This was, however, over a month and a half after shipment. I called Caremark on Tuesday to report the dead insulin and ask them to ship out new insulin and after speaking with 4 people I finally spoke directly with a pharmacist who told me it would be no problem and she’d overnight it. Thursday, I still did not have it and called again to see the status of the shipment. Turns out the pharmacist did not have the clearance necessary to approve the shipment so it had gotten denied in the system and never shipped. Now, I understand that the pharmacist may not have known she didn’t have the proper clearances but what I don’t understand is why no one called me when they decided they were not going ship out my emergency order of my life sustaining drug. Were they hoping I didn’t notice if it didn’t arrive. The poor girl who told me all of this on the phone was absolutely wonderful and reached higher and higher into management to get me proper service but she had to deal with my wrath as I realized that Caremark had promised me insulin and then not bothered to call me to let me know they’d decided not to ship it. This sort of irresponsibility on their part really shocked me and seems akin to medical malpractice from a pharmacy. I don’t know if there’s anyone I can officially complain to but I wanted to share it with anyone reading this posting.
I have been ordering insulin for many years….. I do not think it is silly to order insulin. Insulin at the pharmacy cost $100 per vial, while mail order is 100 dollars for a 90 day supply. So figure it out what if you use 7 vials in 3 months, I personally do not have 700 dollars……. I agree that CareMart should ship with frozen packs in the container…… Everyone should complain and report it to the pharmacists… also…
Medco ships with ice packs……