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Crohn's Disease Forum » Treatment » Humira/Adalimumab » Pharmacy handling of Humira


01-08-2014, 04:04 PM   #1
WebJunk
 
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Pharmacy handling of Humira

I have had several issues with keeping my Humira cold. Everything from a refrigerator not working to transporting it on a long car trip. Everytime I have called the 800-4-Humira and asked I get different answers from their "experts" pertaining on the handling of the Humira. This in addition to all the various posts on here.

Today I went to my CVS pharmacy (previously had it shipped to me) to pick up my Humira prescription. It was sitting on the back counter waiting for the pharmacist's sticker and when the girl handed it to me it was completely warm. The pharmacist said it had only been out about an hour but when I walked up, it was in the pile of unprocessed prescriptions. I refused it since the Abbvie experts warned me strongly about it getting warm and then putting it back in the refrigerator. I had been told yesterday by CVS it would be available for my pickup after 8:30am and I arrived at 2:30pm and when I got to the register it still was not processed, just in the pile. Maybe it had been out since 8:30! The pharmacist called me a little while later and made a claim that the girl took it out of the refrigerator no more than 20 minutes before he handed it to me but I waited in line more than 20 minutes before asking for it and that pile was there when I arrived. He also said he would not dispose of it because it is too expensive.
My last injection was out longer than it should have been and I did not have the usual after-effects and my condition feels like it has worsened the past two weeks so it makes me even more concerned about the handling.

Thinking of switching yet again to a different pharmacy, though not sure others would be different and obviously at least at this CVS they do not care.

Anyone had any issues with how the pharmacy handles their Humira? Or wonder about it? Any thoughts if the Humira is handled the same way along the distribution chain? Could be warmed up several times without knowing it?
01-08-2014, 04:31 PM   #2
blackli
 
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Wow! I would definitely change pharmacies. I like to deal with smaller ons where you get to know the pharmacist well. Go in and meet him/her and if you explain your concerns, I'm sure they will bend over backwards for your business. CVS won't even know you have left!
01-08-2014, 04:44 PM   #3
PsychoJane
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Hello!
I will only share with you what I recently read on the Humira Progress website (canadian support program from Abbvie). Dr.Who recently posted the link so I went on and looked at the FAQ's after he mentioned on a post that the medication could remain out of the fridge for a period of 14 days :O (Say what!!)

Surprisingly enough, it is actually the information they provide on their website. It clearly say that the product should remain between 2-8Celsius in the refrigerator but that if needed, the product can be remain out of the fridge (up to 25 Celsius at the most) for a single period of 14 days. If it was out of the fridge, it NEEDS to be used within a 14 days even if it is put back in the fridge.

Assuming they give you a two pen box and you inject every second week, that means that there handling makes it that you would have to discard one of the two pen...

http://humira-progress.ca/en/cd/faq.php
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01-08-2014, 05:27 PM   #4
WebJunk
 
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that if needed, the product can be remain out of the fridge (up to 25 Celsius at the most) for a single period of 14 days. If it was out of the fridge, it NEEDS to be used within a 14 days even if it is put back in the fridge.
That is not what either I was told on the phone by Abbvie or in any of the written material that I read carefully. But as I mentioned before, there seems to be conflicting info all around.
I am not from Canada nor is the Humira I get so cannot access that website you gave.

Assuming they give you a two pen box and you inject every second week, that means that there handling makes it that you would have to discard one of the two pen...
That could explain why my last injection seemed to have no effect at all positive or (side-effects) negative and instead been feeling worse Crohn's wise. Although it came from a different (Prime Therapeutics) pharmacy that shipped the Humira. Don't know how they handled it.
Also I currently have the flu (the Real flu , not side-effects) so while I was picking it up today, my GI doctor already said to skip this week. So the first pen would be seven days and the second pen would be twenty-one days.

Have to say, I was considering giving up on the Humira because of how lousy I've been feeling lately, but based on the responses here, maybe the Humira I received was ruined? So I should keep trying it.
Very much appreciated.
01-08-2014, 05:31 PM   #5
WebJunk
 
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Wow! I would definitely change pharmacies. I like to deal with smaller ons where you get to know the pharmacist well. Go in and meet him/her and if you explain your concerns, I'm sure they will bend over backwards for your business. CVS won't even know you have left!
Sounds like a great idea to change. Unfortunately, I think my insurance only covers CVS or Walgreens locally. None of the small ones. So my choice would be to change to Walgreens or back to another mail-order pharmacy but not Prime.
01-08-2014, 05:41 PM   #6
Dr.Who
 
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someone mention my name? lol

years ago, i called up progress, they said that a humira pen could be left outside the fridge at room temp for up to 21 hours.. say for example, if you wanted to warm it up before injecting yourself so it would sting less.. but as you pointed out, from the manufacturer to the end user, who knows where your auto inject pen has been, right? ..so i think they should have a label on the pen that turns black when it gets to warm or too cold, just some way you can tell for certain whether its gone bad or not.



.. now, how come my iphone isnt charging, its plugged in.. lol
01-08-2014, 05:49 PM   #7
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i called up progress, they said that a humira pen could be left outside the fridge at room temp for up to 21 hours.. say for example, if you wanted to warm it up before injecting yourself so it would sting less.. but as you pointed out, from the manufacturer to the end user, who knows where your auto inject pen has been, right? ..so i think they should have a label on the pen that turns black when it gets to warm or too cold, just some way you can tell for certain whether its gone bad or not.
My last injection was on Christmas day (Spent the entire day & evening watching Doctor Who on BBC America) and called the 800-4-Humira to have a nurse help me over the phone (yes I still am uncomfortable with it) but because it was a holiday had to wait for a call-back. Since I took it out of the fridge before I called it was out over an hour, normally its five or ten minutes. When the nurse called me back, she asked me Three times if I asked the doctor previously about taking it out that long before I inject. And even strongly suggested that I try to contact the doctor that day (but it was Christmas) before injecting to make sure it was alright.
Seems to be a lot of conflicting info & ideas of what is safe with the medicine. Unless of course the medicine, packaging or formulation is different in Canada.
01-08-2014, 07:49 PM   #8
WebJunk
 
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For anyone who is interested:
I called up my Insurance (Florida Blue Cross) to find another local pharmacy. Called through the Florida Blue Member services number but when you ask for anything pharmacy related you are connected to Prime Therapeutics although they don't upfront identify themselves as such. Prime is actually owned by Blue Cross so they try to get you to use them first, although if you push can get additional names.
While on the phone, I mentioned the last pen had no medical effect and was told to mention that to one of their pharmacists. The pharmacist would only tell me they pack the Humira with two ice packs and that should be sufficient for overnight transport. She would not comment on refrigeration before or during packing. Is the patient the only person interested in the usability of medicine?


I am going with Lisa's suggestion of using a smaller local pharmacy if they can get it. Thanks everyone!
01-08-2014, 07:51 PM   #9
tfowler21
 
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Hello, I have had several instances where my pharmacy knows that I need the Humira every two weeks, but everytime I go to get it refilled, what do you know I have to wait a few days before they can get it in. Pretty frustrating
01-08-2014, 10:38 PM   #10
WebJunk
 
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Just a little more info someone might someday find useful:

On that Canadian site it says:

Once taken out of the refrigerator, HUMIRA must be used within 14 days even if it is put back in the refrigerator. If not used within 14 days, HUMIRA must be discarded.

Record the date when HUMIRA is first removed from the refrigerator.


If Humira is removed at some point anywhere in the supply chain, then the Humira is only good for 14 days after that, so without knowing that date, people may at times be getting Humira with a limited lifespan without knowing it.
01-12-2014, 03:04 PM   #11
scoutfinch
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I can commiserate with your pharmacy issues, WebJunk. I get my Humira through mail order, and it usually gets to me just fine (I call on Monday and it arrives on Wednesday in a freezer pack). But last month the shipment got delayed and I received the package 3 days late. When I opened the package, the ice packs were melted (though still cold) and I wasn't sure what to do. I call the insurance company and they said that they would not replace the shipment because the delivery delay was not their fault. They advised me to call AbbVie, the Humira manufacturer, which I did. The rep I spoke with at AbbVie seemed familiar with this type of situation and agreed to send me a one-time replacement for free - which I found pretty generous. However, I'm now afraid of future delivery mishaps.

Also, the AbbVie rep said that I should probably (an ambiguous answer from the manufacturer) throw out the Humira that was delivered late.

But, now that you mention it, I suppose we don't ever really know if there is a disruption in the supply chain. I like Dr.Who's suggestion about having a temperature/time sensitive sticker on the Humira pen that turns color when it has been exposed past a certain temp/time. As long as the sticker is reliable and effective, that is. When AbbVie sent me the replacement Humira, there was a temp/time sticker on the boxed Humira (it indicated that it was still good, since it hadn't turned red yet), but even when I took the sticker out of the box and left it on my desk at room temp, it still didn't turn red. I don't know if the sticker was defective, or maybe I'm mistaken in the way the sticker should work, but it was a little disturbing. At this point, I can only trust that when I get my Humira shipment and the ice packs are still frozen, that it is still in good condition. It's really a matter of trust, I guess.
01-12-2014, 08:02 PM   #12
SupportiveMom
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I have had issues with my pharmacy and Humira but most of the issue has been understanding how to process payment or understanding the dosage refills. Our insurance covers 80%, the Abvie patient care covers the balance. That SHOULD mean i pay nothing. Every week they screw it up saying I pay anywhere from $3 to $75. I have developed a relationship now with the head pharmacist who seems to now deal with it directly. Creating that relationship is so far making a positive difference. Sometimes getting to the top makes them pay attention just a little more.

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01-13-2014, 11:02 AM   #13
WebJunk
 
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The rep I spoke with at AbbVie seemed familiar with this type of situation and agreed to send me a one-time replacement for free - which I found pretty generous. However, I'm now afraid of future delivery mishaps.

Also, the AbbVie rep said that I should probably (an ambiguous answer from the manufacturer) throw out the Humira that was delivered late.
Another instance of different answers from the manufacturer concerning handling & temperature. Can I ask where you are located? Its not in your profile. Trying to see if country matters which could be product difference or rules from FDA, HPB, DHHS, etc.

But, now that you mention it, I suppose we don't ever really know if there is a disruption in the supply chain. I like Dr.Who's suggestion about having a temperature/time sensitive sticker on the Humira pen that turns color when it has been exposed past a certain temp/time.
I agree there should be a sticker from the manufacturer to know if the medicine was not kept properly. Beginning to think that all along the distribution chain there is a lack of concern for temperature. Something that needs to be investigated further.
01-13-2014, 11:23 AM   #14
scoutfinch
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I'm located in the US (New York City to be exact).

I agree that AbbVie really needs to provide further detailed information about the breakdown (denature? disintegration?) rate of Humira in various exposure conditions. I can't imagine that they haven't done extensive experiments around this.
01-13-2014, 12:07 PM   #15
WebJunk
 
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FOLLOW-UP:
I visited several pharmacies locally. I asked at each about their handling & processing of the Humira. Two of them told me I have not been the first to be asking those questions. Only one completely refused to discuss it with me so that one obviously I won't have anything to do with.
At one I met a woman pharmacist who used to work at the same CVS location that left my Humira out. She said she was told while working there that there was no issue with Humira (should have asked about other refrigerated medicines, So Sorry) being left out while processing & filling orders. Partly that it would be too time consuming to have to walk to the refrigerator everytime. Depending how busy they were, it could be left out for several hours. When she moved to the new pharmacy she was told that practice is not allowed.
The pharmacy I ended up choosing says when the Humira is delivered, it immediately goes from the cooler its packed in to the refrigerator. And taken out of the refrigerator only when ready to put the label on it. Of course I have to take each pharmacist's word for it. But this one was one where I was the second person to ask about handling, is relatively small so not be time-consuming like the other pharmacist mentioned and the pharmacy seems to be their only real business.

My problem with the CVS/Caremark pharmacy here might be limited to this one location. Even the former CVS pharmacist did not mention how they handled it at other CVS locations. It might be a local decision or corporate I just don't know.
One local pharmacy on Friday did admit they "leave the Humira out long enough only to fill the prescriptions" "but it was nothing I should worry about." When I showed them the printout from that website, they said "they handle it according to acceptable standards."
Need to mention freezing. One pharmacy I stopped at keeps their refrigerator at 32F (0C). I question that the Humira could freeze and recommended temp from Abbvie is 36F (2.22222C) They said it was at the front of the refrigerator so will never freeze. But they close at night so its not being opened then and the entire frig can freeze, right?
As I and other people here have mentioned, this might be a larger issue than just the local pharmacy. Anywhere in the distribution chain it can be subjected to the wrong temperature & handling and that could make your Humira ineffective.
Do not expect anyone who handles it wrong to dispose of it. As my local CVS pharmacist said, he was absolutely going to sell the medicine to someone else. This stuff is too expensive for anyone to take a hit. As scoutfinch said, only the manufacturer would take a one-time expense of replacing it and how much does that really cost them?
I highly recommend people ask their current or future pharmacist (not just a worker) how they handle & store the Humira.

My CD symptoms have been getting much worse, especially the past week or two. I was under the impression the Humira was not working at all, but now believe it was doing something. Taking into account my last injection on December 25th was no good and I had to skip last week because I had the flu (yes the REAL FLU not my usual Humira side-effects) its been over a month (Dec 11) since my last good dose of Humira. Hoping to take it this Wednesday but, while over the flu, can feel some pain in my chest though don't hear any crackling. Going to my GP tomorrow to be checked. Hope its not pneumonia (I get it twice a year) don't want to take Humira if it is.

Hope someone finds something in everyone's posts on here helpful.
01-14-2014, 10:23 PM   #16
Ckoenig
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Wow that is crummy! Sorry! I get mine from Acaria? I believe. IT comes in the mail and is between 2 ice packs and in a cooler. I actually had a Humira nurse come to my house and leave all her info and be very supportive. I wasn't offered any other options, but I am thankful that mine is not handled in that manner.

I have had several issues with keeping my Humira cold. Everything from a refrigerator not working to transporting it on a long car trip. Everytime I have called the 800-4-Humira and asked I get different answers from their "experts" pertaining on the handling of the Humira. This in addition to all the various posts on here.

Today I went to my CVS pharmacy (previously had it shipped to me) to pick up my Humira prescription. It was sitting on the back counter waiting for the pharmacist's sticker and when the girl handed it to me it was completely warm. The pharmacist said it had only been out about an hour but when I walked up, it was in the pile of unprocessed prescriptions. I refused it since the Abbvie experts warned me strongly about it getting warm and then putting it back in the refrigerator. I had been told yesterday by CVS it would be available for my pickup after 8:30am and I arrived at 2:30pm and when I got to the register it still was not processed, just in the pile. Maybe it had been out since 8:30! The pharmacist called me a little while later and made a claim that the girl took it out of the refrigerator no more than 20 minutes before he handed it to me but I waited in line more than 20 minutes before asking for it and that pile was there when I arrived. He also said he would not dispose of it because it is too expensive.
My last injection was out longer than it should have been and I did not have the usual after-effects and my condition feels like it has worsened the past two weeks so it makes me even more concerned about the handling.

Thinking of switching yet again to a different pharmacy, though not sure others would be different and obviously at least at this CVS they do not care.

Anyone had any issues with how the pharmacy handles their Humira? Or wonder about it? Any thoughts if the Humira is handled the same way along the distribution chain? Could be warmed up several times without knowing it?
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01-18-2014, 01:15 PM   #17
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When I was on Humira I had to order through my prescription drug insurance specialty pharmacy. They were very good with the ordering process and how they handled the shipment. Overnight delivery packed with multiple ice packs, required a signature so that it wouldn't sit outside. I personally just wouldn't feel comfortable with how your pharmacy handled the medication.
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