What is red flagged at pharmacy?: Identifying and resolving prescription red flags

According to the DEA, pharmacists have a “corresponding responsibility” to ensure that controlled substances are dispensed only for a legitimate medical purpose. This legal obligation means a pharmacist must identify and resolve red flags, which are specific warning signs of potential drug abuse or diversion, before dispensing a prescription.

Quick Summary

Pharmacy red flags are warning signs indicating a prescription may not be legitimate. Pharmacists are legally required to investigate these issues, which can include unusual patient behavior, irregular prescribing patterns, or suspicious prescription details, before dispensing controlled substances.

Key Points

• Corresponding Responsibility: Federal law mandates that pharmacists share the responsibility with prescribers to ensure controlled substance prescriptions are legitimate.

• Patient Red Flags: Warning signs include nervous behavior, frequent early refills, paying cash for controlled substances, and traveling long distances to fill prescriptions.

• Prescription Red Flags: Pharmacists look for altered or forged prescriptions, unusual quantities, specific drug cocktail requests, or signs of therapeutic duplication.

• Prescriber Red Flags: Red flags can involve irregular prescribing patterns, prescribing outside of a specialty, or a significant distance between the patient, prescriber, and pharmacy.

• Documentation is Key: Pharmacists must document their due diligence, including checking the PDMP and contacting the prescriber, to justify filling or refusing a prescription.

• Legal Consequences: Failure to resolve red flags can lead to severe penalties for the pharmacy, including license revocation and criminal liability.

The pharmacist's corresponding responsibility

Federal law, specifically the Controlled Substances Act (CSA) and DEA regulations, imposes a "corresponding responsibility" on pharmacists. This means pharmacists have a legal and ethical duty to ensure that every prescription, particularly for controlled substances, is for a legitimate medical purpose. Both the prescriber and the pharmacist can face consequences for improper dispensing. When a red flag appears, pharmacists must conduct a reasonable inquiry to verify the prescription's legitimacy before dispensing. Failing to investigate can lead to significant penalties, including license issues and criminal charges.

Categories of pharmacy red flags

Pharmacy red flags generally fall into three categories: patient behavior, prescription details, and prescriber patterns. Pharmacists rely on their training and judgment to identify these signs, which are meant to ensure safety, not hinder legitimate care. For more detailed information on specific examples of patient, prescription, and prescriber red flags, you can consult {Link: Frier Levitt https://www.frierlevitt.com/articles/pharmacy-alert-recognizing-and-resolving-red-flags-when-dispensing-opioids/}.

The pharmacist's response: Due diligence and documentation

Upon identifying a red flag, pharmacists must perform "due diligence" to investigate and resolve the concern. If unresolved, the pharmacist must refuse to fill the prescription. Thorough documentation of this process is essential and legally required.

Actions a pharmacist may take include:

• Checking the state's Prescription Drug Monitoring Program (PDMP) to review the patient's controlled substance history and identify potential doctor shopping.
• Contacting the prescriber's office to verify prescription details.
• Engaging in a respectful conversation with the patient to clarify information.
• Documenting all communications and findings, including the decision to fill or refuse the prescription.

Comparison: Legitimate vs. red-flagged prescription scenarios

Feature	Legitimate Prescription	Red-Flagged Prescription
Patient Behavior	Presents with a clear diagnosis, answers questions directly, and is a known patient to the pharmacy.	Appears nervous, exaggerates symptoms, requests specific brands, or pressures the pharmacist.
Payment Method	Uses insurance, or cash payment is infrequent and for a plausible reason.	Consistently pays cash for controlled substances, even when insurance coverage is available.
Prescribing Pattern	Consistent prescriptions from a single, local provider, with doses adjusted as needed.	Multiple similar prescriptions from different distant prescribers, or identical prescriptions for groups of patients.
Travel Distance	Patient and prescriber are in the same general geographic area.	Patient travels a long distance to fill the prescription, potentially crossing state lines.
Prescription Details	Prescription is clear, meets all legal requirements, and is for a quantity typical for the condition.	Prescription has unusual quantities, looks altered, is photocopied, or uses incorrect medical abbreviations.

Conclusion

Understanding what is red flagged at pharmacy is central to preventing drug diversion and ensuring patient safety, particularly with controlled substances. Pharmacists play a critical role as the final check, using vigilance and due diligence to protect public health and ensure legitimate patient access to medication. Resolving red flags and proper documentation are fundamental aspects of pharmacy practice.

Further reading: You can learn more about DEA guidelines and regulations related to controlled substances and red flags on the official DEA Diversion Control website.

Frequently Asked Questions

What happens if a prescription is red flagged at a pharmacy?

If a prescription is red flagged, the pharmacist has a duty to investigate the warning signs. This may involve checking the state's Prescription Drug Monitoring Program (PDMP), contacting the prescribing doctor for verification, or asking the patient follow-up questions. The pharmacist will either resolve the issue and fill the prescription or, if concerns remain, refuse to dispense it.

What is 'corresponding responsibility' in pharmacy?

Corresponding responsibility is the legal and ethical obligation of a pharmacist, alongside the prescriber, to ensure that any controlled substance prescription is issued for a legitimate medical purpose. This responsibility is enforced by the DEA and requires the pharmacist to use their professional judgment to identify and resolve potential red flags.

Can a pharmacist refuse to fill a prescription?

Yes, a pharmacist is legally and ethically obligated to refuse to fill a prescription if they cannot verify its legitimacy or if red flags cannot be resolved. This is part of their professional judgment and corresponding responsibility to prevent drug diversion and abuse.

What is a PDMP and how does it help with red flags?

A PDMP is a state-run database that tracks prescriptions for controlled substances. Pharmacists use it to check a patient's prescription history, which helps identify patterns like "doctor shopping" (visiting multiple prescribers) or filling at multiple pharmacies, both of which are red flags.

Why would paying with cash be a red flag?

Paying with cash can be a red flag because individuals attempting to divert or abuse controlled substances may do so to avoid insurance company scrutiny, which often flags suspicious or unusual prescription patterns.

What are the common prescription details that raise red flags?

Common red flags on a prescription include unusually large quantities, requests for a specific combination of drugs known for abuse (like the "Holy Trinity"), altered handwriting, or signs that the prescription has been photocopied.

What happens if a legitimate prescription is red flagged?

A red flag doesn't automatically mean the prescription is illegitimate. If a pharmacist can resolve the concern through proper due diligence—such as verifying the details with the prescriber and documenting the resolution—they will proceed with filling the prescription. The extra scrutiny is a safety measure to protect both the patient and the public.