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Pharmacists Are Over-Looked Travel Specialists
As the summer months approach, pharmacists can offer many services to ensure patients remain safe and healthy during their travels.
Summer is here and a slew of travel plans are already being made. Pharmacists are often overlooked travel specialists and can offer patients useful tips to ensure they stay adherent to medication during their travels. We can also provide guidance on taking the necessary steps prior to travel to stay safe and healthy, whether staying within the United States or traveling internationally.
Passports to world travel | Image credit: Christian Delbert - stock.adobe.com
Utilizing Community Pharmacies While Traveling
If patients are traveling within the United States or United States Territories where chain pharmacy locations like Walgreens, CVS, or Rite Aid are present, patients can fill majority of their prescriptions while traveling. Before providing this as an option to patients, however, consider regulations surrounding controlled substances and transfer laws in the state or territory where the transfer is being sent. It is important to recommend that patients carry their prescription drug information with them while traveling, but another option is to encourage patients to keep the phone number of their current pharmacy so that the prescription information can be identified when needed.
Insurance Considerations
Some insurance companies offer patients “vacation overrides” and patients should contact their pharmacy prior to travel to see if their insurance offers this benefit. In the event insurance does not offer overrides or there are no overrides remaining for the year, consider 1-time fills of medications through discount coupons or pharmacies such NeedyMeds, GoodRx, or Cost-Plus Drugs. Begin this process 4 weeks prior to travel to ensure there is enough time to overcome unexpected barriers.
Importantly, filling medications outside of insurance coverage may only be an option for generic medications due to cost. If patients are unable to obtain a medication supply for their travels, they should consider contacting their health care provider for alternative options while traveling.
International Travel
Whether patients are traveling to a bustling city center or a town off the beaten path, make sure they are prepared for different pharmacy laws and products abroad. According to the CDC, all international travelers should obtain an official letterhead note from their physician describing all medications and a brief description of the condition(s) they are being used for.1,2 Provision of this letter will be helpful should patients require medical care abroad or in the event their luggage gets searched.
Of note, pharmacy laws vary from country to country; patients must ensure that the medications they are taking here in the United States are not illegal in any country they will enter during their travels, including short layovers at airports.3 To determine if medications are allowed to be brought into other countries, consult the specific country’s embassy website and/or the International Narcotics Control Board for additional information.3,4
Some countries may subject certain medications to quantity limits which may not last patients the entire trip, have restrictions against the medication, or require additional documentation before entering the country with certain medications.3 For example, Japan has a list of prohibited substances from entering their country, including any products containing pseudoephedrine or ephedrine in their pharmaceutical form.
Those traveling to Spain require a doctor’s certificate endorsed by the health authorities of the country of residence for any medication brought into the country. Patients traveling to Spain who will be continuing therapy with methadone or buprenorphine are limited to carrying a 30-day supply and are required to apply for and carry around a health permit called the "certificado para el transporte de estupefacientes y/o psicótropos para tratamiento médico personal,” which translates to “certificate for the transport of narcotic and/or psychotropic drugs for personal medical treatment.” All other narcotic drugs and psychotropic substances are limited to a 30-day supply when brought into Spain.3
Often, United States medication trade names are available under different trade names abroad. Pharmacists can help familiarize patients with the generic name of their medication as it may be more recognizable should the patient need to visit a foreign pharmacy.
Lastly, pharmacists should remind patients that prescription insurance is a United States benefit. Many countries abroad do not take prescription insurance so they will be paying out-of-pocket should they need medication from the pharmacy abroad.5
Flying With Medications
When traveling via airplane, always ensure that medications are packed in carry on or personal bags, as checked baggage loss can be unpredictable. In 2022, 2.2 million bags were mishandled by US operating carriers.6 Keeping medication in carry on or personal bags can help ensure patients are not without their medication.
According to the Transportation Security Administration (TSA), medication in capsule or tablet form can be brought in unlimited quantity onto a flight with proper screening, identification, and documentation. If it is a liquid medication over the standard 3.4-ounce limit, airlines allow it on the plane as long it is in reasonable quantity for the duration of the complete travel to the destination. Liquid medications will be subject to additional screening, and pharmacists should encourage patients to tell TSA officers if they are in possession of prescription liquid medication.5
Immunizations
The CDC updates the Yellow Book every 2 years as a resource for health professionals providing care to international travelers.7 Based on the travel destination, the Yellow Book provides travel health notices; recommendations for vaccinations or medications to take prior to, during, and after travel to prevent or treat infectious diseases; and information pertaining to non–vaccine-preventable diseases.8 Pharmacists can consult this resource to aid patients in ensuring they are properly vaccinated before their trip.
Vaccine billing varies depending on if the insurance is commercial or state funded. Pharmacists can help patients identify the best place to receive necessary vaccines based on insurance coverage. Vaccination locations may include local pharmacies, primary care physician clinics, or travel medicine clinics.
In addition, contacting the insurance company directly will be the most accurate way to determine which vaccines are covered and under which part of patients’ insurance for commercial plans (i.e. medical benefit or prescription benefit). Vaccines covered under Medicare Part B include influenza, pneumococcal, hepatitis B vaccines, and vaccines directly related to the treatment of an injury or direct exposure to a disease or condition, such as rabies and tetanus.9 Part D plan formularies must include all commercially available vaccines except those covered by Part B.9 Pharmacists can consult specific state medical assistance programs for a complete list of vaccines covered.9
As the summer months approach, pharmacists can offer many services to ensure patients remain safe and healthy during their travels. From ensuring appropriate medication access to identifying resources on legality of medications abroad, pharmacists possess a unique, often overlooked, skill set for patient travel.
References
1. Mobility International USA. Medications when traveling internationally. Accessed April 11, 2023. http://www.miusa.org/resource/tipsheet/medications.
2. Centers for Disease Control and Prevention. Traveling Abroad with Medicine. Accessed April 11, 2023. https://wwwnc.cdc.gov/travel/page/travel-abroad-with-medicine
3. International Narcotics Control Board. Country Regulations for Travelers Carrying Medicines Containing Controlled Substances. Accessed April 11, 2023. https://www.incb.org/incb/en/travellers/country-regulations.html#J
4. US Embassy. Websites of U.S. Embassies, Consulates, Diplomatic Missions, and Offices Providing Consular Services. Accessed April 11, 2023. https://www.usembassy.gov/
5. The Oley Foundation. TSA Travel Tips Tuesday - Traveling With Medication. Accessed April 11, 2023. https://oley.org/page/TSA_Travel_with_Meds
6. The Office of Aviation Consumer Protection. Air Travel Consumer Report; November 2022. Accessed May 1, 2023.
7. Centers for Disease Control and Prevention. CDC Yellow Book 2020. Health Information for International Travel. Accessed April 11, 2023. https://wwwnc.cdc.gov/travel/page/yellowbook-home-2020
8. Centers for Disease Control and Prevention. CDC Yellow Book 2020- Destinations. Accessed April 11, 2023. https://wwwnc.cdc.gov/travel/destinations/list
9. Centers for Disease Control and Prevention. How to Pay for Vaccines. Accessed April 11, 2023. https://www.cdc.gov/vaccines/adults/pay-for-vaccines.html#medicare
