PDL continues to see notifications involving forged prescriptions and would like to remind pharmacists of the need to be vigilant when assessing the validity of prescriptions.
Forgery red flags
Forged prescription incidents often involve one or more of the following:
- The prescription is for fentanyl, high strength oxycodone or alprazolam, especially if multiple PBS pack sizes are ordered.
- The patient or prescriber are from outside the local area.
- The patient presents on the weekend or after usual business hours.
- The prescription has not been recorded on the RTPM system.The patient or prescriber have phoned ahead to check if the stock is on hand.
- The patient is overly friendly and talkative (a distraction).
The presence or absence of these commonalities alone is not enough to definitively conclude whether a prescription is a forgery, but pharmacists should be on high alert when presented with any of these scenarios and take extra care.
PDL tips to prevent dispensing from a forged script
1. Contact the prescriber
- Check the prescriber details using an independent resource such as Google, White Pages or check the AHPRA register regarding the principal place of practice.
- Check that the clinic’s address and phone number exist.
- Sophisticated forgeries often display false contact details. Pharmacists who have called the phone number on the script have reported speaking with a “real” receptionist and “prescriber”.
- If a prescription is seemingly valid but the prescriber is not available, consider providing a
small verification supply if permitted by your state legislation.
2. Check recent communications
- Notification of recently identified forgeries are often distributed to pharmacies from the DOH, prescribers or other pharmacies. Ensure that these are easily accessible in the dispensary.
- Stay up to date with published lists of lost, stolen or forged prescriptions if available from your local health department e.g., NSW Health – Lost, stolen or forged prescriptions. Check not only the prescriber’s name on these lists but the addresses and phone numbers as well. Fake phone numbers are often re-used with different prescriber names and practice addresses and may appear multiple times on the list.
3. Check the Real Time Prescription Monitoring (RTPM) system
- To confirm the prescriber has recorded the prescription check RTPM. This is not 100% reliable as handwritten prescriptions will not display as being prescribed and, in some states and territories, the use of RTPM is not mandatory so the prescribing event may not be recorded.
- Similarly, the presence of a prescribing event on RTPM does not guarantee the prescription is legitimate. The prescriber may still need to be contacted if they are not familiar to you or you are concerned about the validity of the script.
4. Compare handwriting
- Look back at previous prescriptions, if available, from the prescriber and compare handwriting and/or signatures. The examples provided had the same prescriber details on the prescription but vastly different handwriting. Both were forgeries.
5. Don’t be fooled by PBS Authority Approvals
- Sophisticated forgeries often have valid PBS Authority Approvals. PDL reminds pharmacists not to use the existence of a valid PBS Authority Approval as a way of verifying a prescription.
6. Be aware of phone and fax scams
- In this digital age there are very few scenarios that would warrant a prescription for a high-risk medication to be phoned through. If you are not satisfied that the caller is genuine, offer to call them back so that you can make further enquiries such as contacting the prescriber’s usual place of practice.
- Faxed or emailed prescriptions could be sent to multiple pharmacies. Confirm that the fax or email has come directly from a prescriber and verify the prescription as per the steps above. Prescriptions emailed or faxed to a pharmacy by a patient are not legal. PDL is aware of cases where a false email account has been created using the practice name as a reference, however these are often Gmail, Hotmail or Yahoo accounts and unlikely to be genuine.
- Confirm your postal address and confirm the script will be sent directly to you and not handed to the patient. Have a process in place to manage faxed or emailed prescriptions and ensure any prescriptions not received within the timeframe stipulated by your state legislation are reported to your State Health Department.
7. Encourage the use of electronic prescriptions
- Electronic prescriptions are more secure than paper prescriptions. Prescribers should be encouraged to use electronic prescriptions rather than faxing or emailing.
- Electronic prescriptions for high-risk medications must still be verified with the prescriber if they are unknown to you.
PDL would like to remind pharmacists that detected forgeries must be reported to your State Health Department and the police.
For immediate advice and incident support, call PDL on 1300 854 838 to speak with one of our professional officers. We are here to support our pharmacist members 24/7.