And yet even pharmacies have no problem shipping via consumer services in the dead of summer, and show zero care for whether "overnight" actually means "over weekend".
For all day-to-day drugs it's really a precaution rather than anything else. Usually they just become a little less effective by becoming less concentrated, but most of the ones I worked with even the 50/80(?) ones were still fine years later (stored at 50 degrees celsius, 80% humidity (I think? Was 20 years ago)). We had a special warm room where all the samples were kept.
One time I was on a drug that had to be shipped to me from an out of town pharmacy in a refrigerated vehicle. The delivery guy demanded that my apartment leasing office refrigerate it, which led to them almost losing it.
Next time I had it shipped to a local pharmacy instead for pickup. That pharmacy didn’t refrigerate it at all and insisted that was kosher. (They also almost lost it.)
I called the original pharmacy and they assured me it doesn’t actually need to be refrigerated, as long as it doesn’t reach its melting pint of like 100 F.
The package said it needed to be refrigerated.
If you call the company, they can basically answer any question you ask, even for un-approved indications.
But for them to bring it up without you asking is a big Nono.