Prescription Validation Is a Critical Task

Verifying prescription accuracy may be the most important step in the prescription filling process.

Validating a legitimate prescription is the critical step in ensuring the appropriate supply and distribution of medications through the proper channels. Advances have been made to minimize prescription forgery via tamper-resistant and specially made prescription pads and electronic prescribing. However, regulations in some states limit the types of medications that can be prescribed electronically, most notably controlled substances. Because of this, pharmacists must educate all employees on what information to look for when discerning the validity of prescriptions, primarily those for controlled substances.

Ultimately, the decision regarding whether a new prescription is valid comes down to the pharmacist’s professional judgment. However, because of the pharmacy technician’s time and interactions with new prescriptions through the initial data entry process, pharmacists can involve techs in identifying red flags that call into question the validity of new prescriptions. In this way, techs serve as additional filters and important aides to pharmacists in mitigating improper medication use.

Although pharmacists spend large portions of entire ethics and law courses on the elements of valid prescriptions, techs typically have not received as much exposure to this concept.

As pharmacists learn throughout their education, only prescriptions written for a “legitimate medical purpose in the usual course of professional practice”¹ are valid under the law, which was later defined legally as “in accordance with a standard of medical practice generally recognized and accepted in the United States.”²

Although pharmacists verify prescription information after it is entered into pharmacy computer systems, techs first receive the prescriptions and complete data entry.³ The key to educating techs on this front is to ensure that they understand what signs to look for regarding invalid or valid prescriptions, recognizing that they must bring potential issues to a pharmacist rather than attempt to adjudicate situations on their own and try to refuse prescriptions based solely on their own judgment.

The Drug Enforcement Administration (DEA) published a guide, A Pharmacist’s Guide to Prescription Fraud, to provide a reference for pharmacists to ensure that controlled substances are being dispensed for legitimate medical purposes.⁴ The guide’s appendix highlights suspicious circumstances that should give pharmacists pause before filling prescriptions. Some of these cases are appropriate and relevant for techs.

These situations include the following:

• A patient returns to the pharmacy too soon for a refill. The easiest way for techs to validate a prescription is to examine whether a patient appears to be returning to the pharmacy too frequently. Within computer systems, previous fills of a medication are shown within the patient’s profile. Pharmacists should make sure that if techs see that a refill could be too early, they notify the pharmacist, who can then judge the prescription’s validity.
• Be on top of state and store regulations. If techs are aware of the pharmacy’s policies about new prescriptions and pharmacy regulations regarding prescriptions in their state, they can better understand what is required of a prescription and what they can do in response to a questionable prescription. For example, identi- fication requirements vary from state to state not only for patients picking up controlled substances but also depending on whether a prescription is a Schedule II medication or a non—Schedule II controlled substance.⁵ Additionally, requirements vary in terms of the type of paper that prescriptions are printed on or what other pieces of information must be included on new prescriptions, meaning that verifying the validity cannot be done by examining a scan on a computer screen.
• Consider the quantity of a drug prescribed. More experienced techs often become accustomed to certain prescriptions with certain quantities from certain prescribers. By thinking about what they have seen previously, techs can recognize prescription quantities that seem unusual. Once an unusual quantity is brought to the pharmacist’s attention, additional steps can be taken to either refuse or validate a prescription.
• Understand DEA numbers. The DEA has indirectly indi- cated many red flags through revoking agency registration of violating pharmacies.¹ These warnings are retrospective in nature and beyond a tech’s scope of practice, pertaining more to pharmacists’ professional judgment. However, the ability to validate a DEA number is a useful skill for techs if they have questions about a prescription’s authenticity. Techs should understand what a DEA number looks like and how to validate it. They should understand what each of the letters means. Techs should be aware that the first letter represents the type of prescriber and know whether that type of prescriber is authorized to prescribe a particular medication. They should also know that the second letter represents the prescriber’s last name. Techs should also know how many numbers there should be and how to validate that those numbers are correct.

Because of their involvement in receiving new prescriptions, techs must complement the pharmacists’ expertise and knowledge while helping eliminate some of the burden of validating new prescriptions. Certified pharmacy technicians must participate in at least 20 hours of continuing education (CE), including at least 1 hour of pharmacy law. Because of these requirements, pharmacists and pharmacy managers can encourage their certified techs to seek out CE related to prescription validation. This additional knowledge can allow techs to ease the burden of validation on pharmacists.

REFERENCES

• Abood RR, Burns KA. Pharmacy Practice and the Law. 9th ed. Jones & Bartlett Learning; 2020.
• United States v Moore, 423 U.S. 122, 139 (1975).
• Occupational outlook handbook. Pharmacy technicians. US Bureau of Labor Statistics. Accessed May 27, 2020. https://www.bls.gov/ooh/healthcare/pharmacy-technicians.htm
• A pharmacist’s guide to prescription fraud. US Department of Justice. Drug Enforcement Administration Diversion Control Division. February 2000. Accessed May 27, 2020. deadiversion.usdoj.gov/pubs/brochures/pharmguide.htm
• Survey of pharmacy law. National Association of Boards of Pharmacy. Accessed May 27, 2020. nabp.pharmacy/publications-reports/publications/survey-of-pharmacy-law/