{"id":249246,"date":"2025-05-20T15:08:57","date_gmt":"2025-05-20T15:08:57","guid":{"rendered":"https:\/\/peraltafinancing.com\/business\/legal\/pharmacists-be-wary-of-what-the-doctor-orders\/"},"modified":"2025-05-20T15:08:57","modified_gmt":"2025-05-20T15:08:57","slug":"pharmacists-be-wary-of-what-the-doctor-orders","status":"publish","type":"post","link":"https:\/\/fivemor.com\/?p=249246","title":{"rendered":"Pharmacists Be Wary of What the Doctor Orders"},"content":{"rendered":"


\n<\/p>\n

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Last month the U.S. Attorney\u2019s Office for the Northern District of Illinois announced that Walgreens agreed to pay up to $350,000,000 to resolve allegations that its pharmacies illegally filled millions of invalid prescriptions for opioids and other controlled substances in violation of the federal Controlled Substances Act, and sought payment for filling many of those prescriptions by federal health care programs, violating the False Claims Act.\u00a0 Press Release<\/a>, Walgreens Agrees To Pay Up to $350M for Illegally Filling Unlawful Opioid Prescriptions and Submitting False Claims, U.S. Attorney\u2019s Office, Northern District of Illinois, April 21, 2025.\u00a0 The government complaint, filed January 16, 2025, and amended April 18th, alleged that Walgreens pharmacies \u201cknowingly filled millions of unlawful controlled substance prescriptions\u201d between August 2012 and March 2023 \u201cdespite clear red flags indicating a high likelihood that the prescriptions were invalid because they lacked a legitimate medical purpose or were not issued in the usual course of professional practice.\u201d\u00a0 Id.<\/em><\/p>\n

We have regularly posted on recognized prescribing red flags that pharmacists have ignored that resulted in administrative or civil actions by the Drug Enforcement Administration (\u201cDEA\u201d) including against Gulf Med<\/a> and Coconut Grove<\/a> pharmacies in Florida and Zarzamora Healthcare LLC<\/a> in Texas.\u00a0 We thought that it would be instructive to review the prescribing red flags alleged in the recent high-profile Walgreens settlement and complaint for an insight into current DEA dispensing expectations.<\/p>\n

As mentioned in Federal Register Vol. 86, 72703<\/a> (December 22, 2021), DEA emphasized in the Gulf Med decision that prescribing \u201c[r]ed flags are circumstances surrounding a prescription that cause a pharmacist to take pause, including signs of diversion or the potential for patient harm.\u201d \u00a0While the presence of a dispensing red flag does not prohibit a pharmacist from filling a controlled substance, it \u201cmeans that there is a potential concern with the prescription, which the pharmacist must address and\u2026make a record of its resolution, assuming it is resolvable.\u201d\u00a0 Id.<\/em><\/p>\n

For a controlled substance prescription to be \u201ceffective,\u201d that is valid, it must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of their professional practice.\u00a0 21 C.F.R. \u00a7 1306.04(a).\u00a0 Prescribers are responsible for the proper prescribing and dispensing of controlled substances, but pharmacists have a corresponding responsibility to ensure that prescriptions they fill are issued for legitimate medical purpose and in the usual course of professional practice.\u00a0 Id.\u00a0 <\/em>As the Walgreen\u2019s Amended Complaint notes, \u201cPharmacists are professionally educated and trained to recognize and assess red flags and to determine whether a prescription is valid.\u201d\u00a0 Complaint, \u204b 82.<\/p>\n

The Walgreens Amended Complaint recognizes the following prescribing red flags:<\/p>\n

    \n
  1. Prescribers who prescribe the same medication, with the same directions, for the same quantity, for a large number of individuals. \u204b 81.<\/li>\n
  2. Prescriptions of drugs or drug combinations that are frequently sought by individuals known to abuse or misuse prescription drugs, including the combination of an opioid, a benzodiazepine and a muscle relaxant, known as the \u201ctrinity.\u201d \u204b\u204b 81, 86, 251.<\/li>\n
  3. Patients who repeatedly seek early fills of schedule II prescriptions or refills of schedule III-V prescriptions earlier than the date the drug would have run out if taken according to the prescriber\u2019s instructions. \u204b\u204b 81, 89, 251.<\/li>\n
  4. Opioid prescriptions for high dosages and quantities, including prescriptions that individually or in combination, provide patients with daily dosages of greater than or equal to 300 Morphine Milligram Equivalents (\u201cMMEs\u201d). \u204b\u204b 84, 251.<\/li>\n
  5. Patients filling prescriptions from multiple prescribers, particularly for the same type of controlled substance or dangerous combinations of drugs. \u204b 87.<\/li>\n
  6. Patients filling prescriptions at the same time at multiple pharmacies. \u204b 88.<\/li>\n
  7. Patients traveling long distances to the prescriber and\/or to the pharmacy. \u204b 90.<\/li>\n
  8. Patients paying cash or a cash equivalent for controlled substance prescriptions, especially when they use insurance to pay for other prescriptions. \u204b 92.<\/li>\n<\/ol>\n

    The Walgreens Amended Complaint notes that pharmacists \u201cmay be able to resolve a red flag by reviewing the patient\u2019s diagnosis to confirm the drug prescribed is an appropriate treatment for the patient\u2019s condition, reviewing the pharmacy\u2019s dispensing history for the patient or prescriber, contacting the prescriber, or checking the state prescription drug monitoring program (PDMP) database to see all of the prescriptions obtained by the patient.\u201d\u00a0 \u204b 93.<\/p>\n

    As noted in the Press Release<\/a>, along with the monetary payment, Walgreens entered into a seven-year Memorandum of Agreement (\u201cMOA\u201d) with DEA to implement measures to prevent dispensing controlled substances without resolving red flags.\u00a0 The MOA requires Walgreens to maintain policies and procedures requiring pharmacists to confirm the validity of prescriptions prior to filling, provide annual training to employees about their obligations related to controlled substances, ensure that staffing is sufficient to enable employees to comply with their obligations and maintain a system that blocks prescriptions issued by prescribers known to write non-legitimate prescriptions. \u00a0Walgreens also entered a five-year Corporate Integrity Agreement with Health and Human Services-Office of the Inspector General also related to controlled substance dispensing by its pharmacies.<\/p>\n

    The Amended Complaint, MOA and Corporate Integrity Agreement provide sound framework for identifying and not filling prescriptions exhibiting red flags.<\/p>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"

    Last month the U.S. Attorney\u2019s Office for the Northern District of Illinois announced that Walgreens agreed to pay up to $350,000,000 to resolve allegations that its pharmacies illegally filled millions of invalid prescriptions for opioids and other controlled substances in violation of the federal Controlled Substances Act, and sought payment for filling many of those […]<\/p>\n","protected":false},"author":1,"featured_media":245146,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[97],"tags":[3982,26122,4392,87094],"dealstore":[],"offerexpiration":[],"class_list":["post-249246","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-legal","tag-doctor","tag-orders","tag-pharmacists","tag-wary"],"yoast_head":"\nPharmacists Be Wary of What the Doctor Orders - Som2ny Network<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/fivemor.com\/?p=249246\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Pharmacists Be Wary of What the Doctor Orders - 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