Keeping medications refrigerated

Yes, contact the RS office. That said, I often bring a small lunch box size insulated bag. I like to freeze sponges in a ziplock bag to keep things cold. I have never stayed in a hotel in Europe that didn't have a refrigerator guests could access or weren't willing to put items in their refrigerator. In between hotels, use the cooler bag and frozen sponges.

Look online for coolers for insulin. There are several, TSA approved, that work. We have one that works off a frozen pack (not good for TSA), or a battery pack (good for TSA, flights and time on bus) or plugs into wall (good when hotel does not have a fridge, if hotel uses a key card ask for a second card and put a post-it on it in the local language "medical device in use, please do not remove"). We used it on five flights in US and Europe, no one at security even looked at it twice. Longer flights require 2 batteries. One flight had a charging port that accepted the cable.
Price points range from $100.00 to about $140.00. A useful website is 4allfamily.

You can go thru TSA with a freezer pack IF it is completely frozen.

I have eye drops that I keep in a small insulin pack. It uses a gel insert that you soak in water before using. It has been working well for me and has not been a problem with TSA.

I travel with insulin pens and found that all buses used by RS have a fridge unit for chilled water that would be available for meds if needed. Talk to your guide who will talk to the driver and get that organized for you. And all hotels have had mini fridges. I seem to remember the RS office sent out before tours a sheet that tour participants had to fill out having a section on medical issues so mention your need there too.

An easy way to make an ice pack to get through security: use a plastic water bottle. Pour a little bit out, then freeze it overnight. If any has melted by the time you go through security, just drink it. Do the same each night before you move locations or fly home.

I travel with a med requiring refrigeration too. I notified RS of my need for a room refrigerator for medical reasons, and it was accommodated. My med is very expensive, can't be dropped, etc, so I don't like to store it out of my control.

I bring refreezable ice packs in a small insulated bag, for the bus rides. As someone else noted, the ice packs go through TSA with no problem as long as they are frozen solid. I learned that lesson the hard way at SeaTac when one was mushy; after getting the stink eye and a long delay while TSA discussed my error, I just told them to toss it, because I had others.

In the UK I was told that it's a national requirement for hotels to provide refrigeration and/or freezer access as needed for medical reasons - who knew! I neatly package the ice packs in a zip lock with my name, tel, and room number, and take them to the front desk. I don't know if that's the same in other countries, so contact your hotels in advance just to be sure.

I really stressed over this issue the first time traveling after I started taking the med, but you are not alone, and it will be ok.