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Among all the challenges that overworked, understaffed retail pharmacies are dealing with, preventing prescription fraud is uniquely taxing for pharmacy staff. Bad actors’ methods are growing more sophisticated, and fraudulent prescriptions are becoming harder for pharmacists to spot and taking more time to investigate. With pharmacists burning out at a high rate, the risk of prescription drugs falling into the wrong hands is growing.
Joe Tammaro
Pharmacists are the last line of defense against prescription fraud; they bear responsibility for determining if a prescription is valid. Until now, they’ve had little more than their professional judgment and a reference guide published by the Drug Enforcement Administration in 2000 to help them. Ironically, guidance from the era of paper prescription pads provides little to no help detecting sophisticated digital threats.
Fraudsters aren’t just targeting controlled substances like opioids and narcotics; it’s high-cost specialty medications, popular weight loss injectables, HIV medications, and powerful cancer therapies they’re after. They can get them in two ways—with highly sophisticated digital technology or by simply gaining access to a provider or practice administrator’s login credentials. With the latter, the imposter creates fraudulent accounts and generates fake patient information. It’s happened to roughly 10% of the prescribers in the U.S., and many of them are never the wiser.
Here are just a few of the prescriber identity theft and prescription fraud stories making headlines today:
- A Louisiana man is awaiting trial on five dozen counts stemming from a large-scale prescription drug ring in Utah. The charges include forgery and identity fraud.
- A Florida man is in prison awaiting trial on 19 criminal charges related to fraudulent prescriptions sent to pharmacies in seven states earlier this year.
- A Pennsylvania man is serving 28 months in prison for using stolen prescriber IDs to obtain large quantities of opioids at multiple pharmacies across the state.
Pharmacists feel the unrelenting weight of needing to catch every red flag among the several hundred prescriptions that come into the pharmacy daily. They are also expected to take prescribing patterns into account for numerous medical specialties and drugs.
The pressure to keep patients safe and protect prescribers and pharmacies while processing a high volume of prescriptions each day is asking a lot; too much, perhaps, considering that nearly three-quarters of community pharmacists in a 2021 survey said they lacked sufficient time to safely do all the patient care functions in their pharmacy.
When an entire profession is struggling to juggle multiple high-risk priorities, as pharmacy is currently, that’s a leading indicator of the need to turn up technology and innovation. Automation and AI-enabled tools are already proving how transformative they can be to pharmacy operations, fulfillment, and delivery. The changes so far are promising, from the use of robotics to streamline dispensing to the expansion of central fill automation. There’s much still to do, especially around burden reduction.
For DrFirst and others developing AI solutions to streamline pharmacy workflow, the next phase of burden reduction is here. Machine learning algorithms can be trained to analyze incoming prescriptions and detect unusual patterns in prescribing behavior, alerting the pharmacist for a closer look when something doesn’t add up. By taking care of the time-consuming task of pre-screening every prescription that arrives at the pharmacy, AI-enabled solutions can make a sizable dent in the pharmacist’s workload and mental load.
While the industry tackles new ways to protect prescriber identity, advanced tools now allow pharmacists to mount a strong defense against prescription fraud as front-line leaders in patient safety.
Joe Tammaro is Vice President Pharmacy – Patient and Pharmacy Solutions at DrFirst
