The DEA was established as a federal agency to regulate drug laws and to prevent misuse and/or diversion of both controlled substance and non-controlled medications. Their effort to prevent misuse and diversion of controlled substance medications starts with pharmacies filling prescriptions based on valid hardcopies. As was the case for CVS Pharmacies in New Hampshire, red flags that the federal government believes would have alerted a pharmacist of a fraudulent prescription were ignored, resulting in an alleged 41 fraudulent prescriptions being filled for Adderall®, Ritalin®, and Xanax ®. In order to resolve the allegations, CVS agreed to pay $70,000.
This civil case against CVS came as a result of two criminal investigations into individuals who utilized a variety of CVS Pharmacies around New Hampshire to fill fraudulent prescriptions. This speaks to the importance of ensuring the prescriptions that you are filling at your pharmacies are valid and written for a valid medical purpose by a provider within their usual scope of practice.
- Ensure your staff completes the annual Fraud, Waste, and Abuse Training. If you don’t have a compliance program at your pharmacy, check out the PAAS FWA/HIPAA Compliance program, which includes training, risk analysis, daily exclusion checking and customized compliance policy and procedure manual (with written policies and procedures – required by Medicare Part D and PBMs).
- Be familiar with your state’s prescription requirements. Examples include:
- Supervising physician for mid-level practitioners
- Alphanumeric quantities on controlled substances
- Security elements on written prescriptions
- How long prescriptions are valid
- Look for elements such as the Surescripts Provider Identifier (SPI), message ID, and transaction ID on electronic hardcopy prescriptions, along with “electronically signed by” or “authorized by” for controlled substances
- Utilize your states Prescription Drug Monitoring Program
- When in doubt, err on the side of caution – contact the prescriber to confirm the prescription prior to dispensing and annotate conversation with a clinical note
- Reference PAAS’ July 2022 Newsline article that helps identify red flags, Beware: DEA and Wholesalers are Cracking Down on Controlled Substance Dispensing