What to Do If Your Mail-Order Prescription Is Exposed to Extreme Temperatures

If you have medications you refill every month, your insurance company may offer mail-order pharmacy services that deliver them to your home. For many people, this can be a convenient option. But how are your medications handled before they arrive at your door?

When medications aren’t stored under the right conditions, they can change physically or chemically. This can cause them to not work as well. The same conditions apply if they’re shipped to your home. That’s why the FDA has strict rules for how pharmacies and distribution centers store them. Those same storage requirements should also be met during transit. 

Here, we’ll discuss how your medications should be transported, when to be concerned about medications being exposed to extreme temperatures, and what you should do if you suspect your medication wasn’t handled properly during the delivery process.

Promotional Disclosureinfo_outlined

SPECIAL OFFER

Save over 40% on Qsymia with GoodRx

Discover the once daily Qsymia for weight management. Qsymia is for adults and children 12-17 in combination with a healthy diet and regular exercise.

Save now

What happens to a mail-order prescription during transport?

Prescription medications usually come with package inserts that include storage requirements. If a medication doesn’t have specific storage requirements, the FDA says it may be stored at controlled room temperature. This is defined as 59°F to 86°F. 

Mail-order pharmacies may use the U.S. Postal Services or companies like FedEx to deliver your medications. But they’re still responsible for putting processes in place to keep your medications at proper temperatures while in transit. 

Examples of steps taken can include:

• Selecting appropriate packaging based on weather conditions. Certain packaging may be needed to maintain safe temperatures based on the shipment time and location. 

• Using temperature-controlled packaging. This can include insulated coolers with varying amounts of ice packs, depending on the weather.

• Using express shipping. Expedited shipping helps cut down on the time your medications are in transit. This can be particularly important for refrigerated medications.

• Placing temperature monitoring devices inside packages. This is the only way to know the temperature inside a package. Some pharmacies will also use them to validate their shipping procedures. 

• Accounting for delays. Sometimes there are instances when packages are left outside for several hours after delivery or take an extra day to arrive.

• Requiring signature for delivery or providing delivery notifications. This can help prevent packages from sitting outside too long after delivery.

But not all pharmacies take the same precautions when shipping medications. You’ll want to ask what steps they take to protect your medication before it arrives.

How do you know if your medication was exposed to high temperatures?

As mentioned above, the only way to know for sure is if a temperature monitoring device was inside your package. But not all packages contain these devices. So, how else can you tell?

Consider the temperature outside. Your medication is more likely to be exposed to high temperatures during warm weather. This may be more likely if it sits outside for a long time after it’s been delivered.

Refrigerated medications should be packaged with ice packs. Are they still partially frozen or are they completely melted upon arrival? If they’re melted, your medication could be affected.

Other signs to look for include:

• The color, smell, or texture of your medication is different than usual

• The medication container is warm to the touch

• Your medication is stuck together, cracked or chipped, or harder or softer than normal

• A temperature tracker inside the package indicates that it got overheated

If any of these happen, temperature could be the culprit. If you take medications with these signs of damage, they may not work as well for you. But keep in mind that medications can be affected by temperature and not look or feel any different than usual.

Are mail-order prescriptions safe to take if they’ve been exposed to extreme temperatures?

A medication’s storage requirements are based on data collected while studying it. Some manufacturers even have data on how long a medication is stable outside of the recommended temperature range. 

Your pharmacist or healthcare provider can use this kind of information to help determine if your medication is still safe to take. 

What are some examples of temperature-sensitive medications?

Some medications are more sensitive to temperature than others. Ask your pharmacist if this applies to your medications. If this is the case, you’ll want to be more cautious about taking it if you suspect temperature control issues. Or, you may opt for pharmacy pickup or local delivery instead of mail order to be safe.

Below are a few common examples of temperature-sensitive medications and things to keep in mind if they’re shipped to you.

Insulin

Insulin should be stored in the refrigerator between 36°F and 46°F. The longer it’s exposed to extreme temperatures, the less effective it becomes. It might look different (e.g., color change, cloudy), but it might also look the same.

Insulin is also sensitive to extremely cold conditions. If it’s packaged with ice packs, it shouldn’t be directly touching them. This can cause it to freeze. And insulin that’s been frozen shouldn’t be used, even after it thaws. 

Some insulin products can be kept at room temperature for 28 days. But they must be thrown away after that. Check with your pharmacist for accurate storage requirements for your insulin.

Levothyroxine

Another example of a temperature-sensitive medication is the thyroid replacement medication, levothyroxine (Synthroid). The prescribing information says to store it at room temperature (up to 86°F). The storage instructions also say to keep it away from heat, light, and moisture. 

Storing thyroid medication at high temperatures can make it lose its effectiveness. One small study reported that improper storage was to blame for around 4.5% of the people in the study having uncontrolled thyroid hormone levels.

Pancreatic enzymes

Pancreatic enzymes, like Creon (pancrelipase), are also sensitive to heat. Heat and moisture will destroy the enzymes. This can cause the medication to not work as well.

Pancreatic enzymes also shouldn’t be refrigerated. They should be stored at room temperature (up to 86°F) with the lid tightly sealed to avoid getting moisture inside. 

What should you do if you suspect your mail-order prescription was exposed to extreme temperatures?

If you received a package from a mail-order pharmacy and think your medication got too hot, too cold, or damaged during delivery, call the pharmacy before taking it. Take note of the condition of the package and its contents when it arrived. Try to estimate how long it was sitting outside after delivery, if applicable.

Your pharmacist or healthcare provider can help you determine whether or not your medication is still safe to take. 

Why trust our experts?

Written by:

Sarah Lobello Pearson, PharmD

Sarah Pearson is a practicing pharmacist with over 10 years of experience in the field. She received her doctorate in pharmacy from the University of Georgia in Athens, GA.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Our editorial standards

Meet our experts