Rule 291.29: A Pharmacist’s Professional Responsibility to Prevent Non-Therapeutic Dispensing of Controlled Substances

Pharmacist Duties to Prevent Fraudulent, Forged, Invalid, or Medical Inappropriate Prescriptions for Controlled Substances

Pharmacists must make every reasonable effort to prevent inappropriate dispensing of prescription drugs due to fraudulent, forged, invalid, or medically inappropriate prescriptions. These duties primarily exist to prevent the non-therapeutic dispensing of controlled substances. As a result, pharmacists must evaluate the totality of the circumstances by looking at various red flag factors, as follows:

• A reasonably discernible pattern of substantially identical prescriptions for the same controlled substances for numerous persons;
• A reasonably discernible pattern of overall low prescription dispensing volume with a relatively consistent 1:1 ratio of controlled substances to dangerous drugs and/or over-the-counter drugs dispensed as prescriptions;
• A prescriber routinely prescribes commonly abused controlled substances, such as opioids, benzodiazepines, muscle relaxants, psychostimulants, and/or cough syrups containing codeine;
• A prescriber’s prescriptions contain nonspecific or no diagnoses, or lack the intended use of the drug;
• Prescriptions for controlled substances are commonly for the highest strength of the drug or for large quantities;
• A prescriber consistently adds dangerous drugs or over-the-counter products to the prescriptions for controlled substances;
• Upon contacting the practitioner, the pharmacist cannot directly speak with the practitioner, the practitioner does not address concerns, or is unwilling to provide additional information;
• The practitioner’s clinic is not registered as, and not exempted from registration as, a pain management clinic by the TMB, despite prescriptions of mostly opioids, benzodiazepines, barbiturates, or carisoprodol, but not suboxone, or any combination of these drugs;
• The controlled substances or quantity thereof are inconsistent with the practitioner’s area or practice;
• The Texas Prescription Monitoring Program indicates the person presenting the prescriptions is obtaining similar drugs from multiple practitioners or receiving similar drugs at multiple pharmacies;
• Multiple persons with the same address present similar prescriptions for controlled substances from the same practitioner;
• Persons typically pay for the prescriptions with cash rather than using insurance;
• Persons present the prescriptions for controlled substances in an abnormal manner, such as multiple people arriving in the same vehicle to pick up controlled substances prescribed by the same practitioner, or one person picking up several prescriptions for controlled substances;
• The pharmacy charges significantly more for the controlled substances than nearby pharmacies, but the persons are willing to pay the additional costs;
• The pharmacy routinely orders controlled substances from more than one drug supplier;
• The pharmacy has been discontinued by a drug supplier related to controlled substance orders;
• The pharmacy has a sporadic and inconsistent dispensing volume;
• The pharmacy does not maintain normal operating hours each week;
• The pharmacy previously has received warnings from the Texas State Board of Pharmacy for inappropriate dispensing of controlled substances.