Pharmacists Are the Last Line of Defense • PBI Education (2024)

May 2017

Pharmacists Are the Last Line of Defense • PBI Education (2)

According to the California State Board of Pharmacy, Pharmacists “are the last line of defense in preventing controlled substances from getting into the wrong hands.” A precedential case in 2013 established that pharmacies have a “corresponding responsibility” to ensure that every prescription they fill for a controlled substance is for a legitimate medical purpose. If they fail in this obligation, they are subject to the same penalties as the physician who wrote the prescription.

State laws differ slightly, but in general, pharmacists must use their own professional judgement to determine if the prescription is legitimate. Jack H. Raber, Pharm.D., has more than 40 years of experience in a variety of clinical settings and now teaches pharmacy risk assessment and management at the University of Southern California School of Pharmacy. Raber, who is also a PBI faculty member, explains, “Pharmacists have to use their training, their education, their skill—the totality of their experience—to determine if a prescription should leave the pharmacy as written or if it needs further investigation.” If the pharmacist has good reason to suspect a problem, he or she must decline to fill the prescription.

High profile prosecutions have brought home the seriousness of this obligation. In 2016, the U.S. Attorney in Massachusetts announced that CVS Pharmacy, Inc. had agreed to pay $3.5 million and entered into a three-year compliance agreement with the DEA to resolve allegations that 50 of its stores violated the Controlled Substances Act by filling forged prescriptions for controlled substances more than 500 times between 2011 and 2014.

This year, the Department of Justice announced that Costco Wholesale would pay $11.75 million to settle allegations that the company’s pharmacies, among other things, violated the Controlled Substances Act by filling prescriptions that were incomplete, lacked DEA numbers, or were for substances prescribed outside the scope of the prescriber’s usual course of professional practice.

Red flags for pharmacists. To help pharmacists quickly and effectively determine if they should fill a prescription, the California Board put together the following list of Red Flags. A pharmacist who notices one or more of these warning signs has reason to be suspicious.

  • Irregularities on the face of the prescription itself
  • Nervous patient demeanor
  • Age or presentation of patient (e.g., youthful patients seeking chronic pain medications)
  • Multiple patients all with the same address
  • Multiple prescribers for the same patient for duplicate therapy
  • Cash payments
  • Requests for early refills of prescriptions
  • Prescriptions written for an unusually large quantity of drugs
  • Prescriptions written for duplicative drug therapy
  • Initial prescriptions written for strong opiates
  • Long distances traveled from the patient’s home to the prescriber’s office or to the pharmacy
  • Irregularities in the prescriber’s qualifications in relation to the type of medication(s) prescribed
  • Prescriptions that are written outside of the prescriber’s medical specialty
  • Prescriptions for medications with no logical connection to an illness or condition

Awareness of the local situation and players is also important. In addition to knowing their state’s requirements for dispensing controlled substances, pharmacists should know the popular drugs of abuse for their area, and get to know local prescribers (and their signatures) as well as their patients.

Other best practices include:

  • Using your state prescription drug monitoring program and paying attention to enforcement actions.
  • Requiring a government-issued photo identification prior to dispensing controlled substances.
  • Calling the number listed in the pharmacy’s system rather that the phone number on the prescription.
  • Communicating with other pharmacies if you receive a prescription that was denied by them or if you deny a prescription.
  • Communicating with law enforcement and regulatory agencies (State Board of Pharmacy, State Medical Board, local DEA office, and local sheriff’s office or police department).
Pharmacists Are the Last Line of Defense • PBI Education (2024)

FAQs

Are pharmacists the last line of defense? ›

You, a pharmacist, are the last line of defense in preventing controlled substances from getting into the wrong hands.

Why are pharmacists leaving? ›

A 2022 National Community Pharmacists Association survey showed that nearly 75% of respondents felt they did not have enough time to safely perform clinical duties and patient care. Stores often operate with just one pharmacist behind the counter for a 12 hour shift.

What is the timeline of education for a pharmacist? ›

It usually takes approximately eight years to become a pharmacist in California. A candidate can expect to spend three to four years completing an undergraduate program and then four more years in their pharmacy program.

What do pharmacists know that doctors don't? ›

People usually see their pharmacists more often than their family doctor. These professionals understand medications, dosages and drug interactions. If a physician writes a patient an incorrect prescription, a pharmacist is the last line of defense to ensure that the patient stays safe.

Is pharmacy a dead field? ›

It is far from dead. If you look around carefully you'll see many pharmacies are making changes to their business model and doing quite well.

Will pharmacists be replaced? ›

As technology and robotics become more advanced, a common question that many individuals working in pharmacy environments have is “will automation replace pharmacists?” To answer that question simply: no.

Why are pharmacists paid so little? ›

Prescription reimbursem*nt has been driven down so low there's not enough margin to pay pharmacists better or afford more help. As the retail pharmacy industry has suffered at the hands of payors, the rest of the pharmacy industry has too. This has caused wage stagnation across the pharmacy profession.

Will pharmacists exist in the future? ›

Fortunately, an increasing demand for physicians,11 combined with projections about people living longer, should create opportunities for pharmacists to evolve and expand their role—perhaps even to become the next generation of primary care providers (PCPs) who treat patients with acute illnesses and manage chronic ...

What is the burnout rate for pharmacists? ›

But the fact of the matter is over 50% of pharmacists have demonstrated burnout and that is being evidenced in those walkouts and clinical unrest in the world of pharmacy.

Do pharmacists go to med school? ›

2. Do You Need Medical School to Become a Pharmacist? No, you do not need to attend medical school in your pursuit of pharmacy. To qualify for a career as a pharmacist, you need to have either a bachelor's degree or a pre-pharmacy diploma, as well as a degree from an accredited pharmacy school.

Do you need a PhD to be a pharmacist? ›

You'll need advanced education and licensure in order to work as a pharmacist. Pharmacists are required to have a doctoral degree and pass multiple exams before becoming licensed. However, you don't need to be a pharmacist to work with patients and medications.

Is being a pharmacist hard? ›

How hard is pharmacy school? On various online forums, the most common answer to this question is that pharmacy school is rigorous and demanding—but not impossible if you're thoroughly committed to earning your PharmD. After the first year of study, approximately 15 percent of Doctor of Pharmacy students drop out.

What are red flags for pharmacists? ›

For example, the California State Board of Pharmacy has published the following list of red flags (other states use the same criteria): Irregularities on the face of the prescription itself. Nervous patient demeanor. Age or presentation of patient (e.g., youthful patients seeking chronic pain medications)

What is unprofessional for a pharmacist? ›

(c) Any dishonest or unprofessional conduct, or gross or repeated negligent conduct in the practice of pharmacy or in performing activities ancillary to the practice of pharmacy or any particular aspect or specialty thereof; (d) Behavior which demonstrates a clear conflict with the basic knowledge and competence ...

Who is the last line of defense against medication errors? ›

As the final step in the administration process and the last line of defense against medication errors, nurses must follow the rights of medication administration to minimize the risk of medication errors: Right patient. Right medication.

Can a pharmacist red flag you? ›

A red flag could be indicative of abuse or misuse, over or under compliance, drug-drug interactions, or a “forged or altered prescription.” Such issues would be reviewed and resolved by a pharmacist “before filling any prescription” as part of the “prospective drug use review,” the testimony states.

Is pharmacist the most trusted profession? ›

Pharmacists Ranked Third Most Trusted Medical Professionals in 2023 Gallup Survey. Pharmacists are ranked as the third most trusted medical professionals among various occupations in Gallup's 2023 Annual Rating of Honesty and Ethics survey.

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