November 06, 2019
Earlier this year, a national pharmacy chain agreed to pay the government $535,000 to resolve allegations that some of its pharmacies had filled dozens of forged prescriptions. This turned out to be the second settlement in the past 3 years by this pharmacy chain to resolve similar charges. The first settlement, in mid-2016, saw the chain paying $3.5 million to resolve allegations that 50 of its stores violated the Controlled Substances Act by filling forged prescriptions for controlled substances.
The 2016 Case
The $3.5 million settlement in 2016 involved 50 pharmacies in Massachusetts and New Hampshire that filled over 500 forged prescriptions between 2011 and 2014. A Drug Enforcement Agency (DEA) investigation revealed that the forged prescriptions traced back to just a few individuals filling many prescriptions. For example, one forger signed a dentist’s name on 56 oxycodone prescriptions and was able to get them filled in five pharmacies. The DEA faulted the pharmacists for not picking up on what should have been obvious red flags in some circumstances. For example, one forger filled 29 forged prescriptions at one pharmacy in a six-month period. The 29 prescriptions totaled almost 1300 hydrocodone pills, or what would have amounted to seven pills a day.
“Pharmacies have a legal responsibility to ensure that controlled substances are dispensed only pursuant to valid prescriptions,” said United States Attorney Carmen Ortiz at the time. “When pharmacies ignore red flags that a prescription is fraudulent, they miss a critical opportunity to prevent prescription drugs from entering the stream of illegal opiates on the back market.”
The 2019 Case
Three years after the 2016 settlement, the same pharmacy chain again settled a case brought against it by the Justice Department based on a DEA investigation. This case involved pharmacies in Rhode Island that filled 39 prescriptions for Percocet that, according to the DEA, the pharmacists had reason to know were invalid or unauthorized.
The charges were based on the Controlled Substances Act and its associated regulations which state that “[t]he responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription.”
The pharmacy chain, while settling the case for $535,000, acknowledged that its pharmacists bear a responsibility to ensure that the prescriptions being filled are valid and legal. The chain denied any wrongdoing but stated that it had agreed to the settlement to avoid the “delay, uncertainty and expense of litigation.”
So, what does this mean for pharmacists? According to the website for the Department of Justice and the DEA’s Diversion Control Division, pharmacists have “a personal responsibility to protect their practice from becoming an easy target for drug diversion. They need to know of the potential situations where drug diversion can occur and establish safeguards to prevent drug diversion.” The Diversion Control Division’s Pharmacist’s Manual goes on to note that the “dispensing pharmacist must maintain a constant vigilance against forged or altered prescriptions.” Ignoring red flags, even if they don’t lead to a lawsuit against you, can lead to a lawsuit against your employer (which could have a negative effect on your employment.)
Be vigilant. The Diversion Control Division suggests the following could indicate a forged prescription:
- A prescription that is too neat with very legible handwriting.
- Quantities, dosages, or directions that differ from typical medical usage.
- Prescription that appears photocopied.
- Directions written in full with no abbreviations.
- Non-standard abbreviations, or textbook abbreviations.
- Different colored inks or different handwriting on the same prescription.
If there is any doubt, it is essential to contact the prescriber for verification or clarification. When in doubt, the Diversion Control Division also recommends asking the patient for proper identification. “Although this procedure is not foolproof (identification papers can also be stolen/forged), it does increase the drug abuser's risk. If a pharmacist believes the prescription is forged or altered, he/she should not dispense it and call the local police. If a pharmacist believes he/she has discovered a pattern of prescription abuse, he/she should contact the state Board of Pharmacy or the local DEA Diversion Field Office. Both DEA and state authorities consider retail-level diversion a priority issue.”
Finally, the Diversion Control Division notes that drug abusers tend to seek out areas where “communication and cooperation between health care practitioners are minimal because it makes the drug abuser’s work easier.”
Ann W. Latner, JD, is a freelance writer and attorney based in New York. She was formerly Director of Periodicals at the American Pharmacists Association.