How to Prevent Early Refills and Duplicate Therapy Mistakes in Pharmacy Practice

Every month, pharmacists face the same frustrating pattern: a patient walks in two weeks early for a 30-day prescription, insists the doctor said it was okay, and seems confused when asked for proof. This isn’t just inconvenient-it’s dangerous. Early refills and duplicate therapy mistakes are silent killers in healthcare, contributing to opioid overdoses, drug interactions, and unnecessary hospital visits. The good news? These errors aren’t random. They’re predictable. And with the right systems in place, they can be stopped before they happen.

Why Early Refills Are a Red Flag

Early refills aren’t always mistakes. Sometimes, a patient loses their pills or runs out early because of an emergency. But when it happens month after month-especially with controlled substances like oxycodone, Adderall, or benzodiazepines-it’s a pattern. The DEA strictly prohibits refills for Schedule II drugs. No exceptions. Yet, some patients still try to get them by visiting multiple pharmacies or switching prescribers. This is called "doctor shopping," and it’s a major driver of the opioid crisis.

Pharmacists aren’t just dispensing pills-they’re the last line of defense. A 2023 report from Pharmacy Times found that nearly 40% of early refill requests for controlled substances came from patients who had filled the same drug at another pharmacy within the past 14 days. That’s not coincidence. That’s risk.

And it’s not just opioids. Patients on blood thinners, diabetes meds, or psychiatric drugs can end up with dangerous overlaps if two doctors prescribe the same thing without knowing the other did. One patient in Edinburgh was found to be taking two different SSRIs at the same time because one doctor didn’t check the other’s notes. He ended up in the hospital with serotonin syndrome. That’s preventable.

How Duplicate Therapy Happens-and How to Stop It

Duplicate therapy isn’t always obvious. It might look like two different brand names for the same drug. Or two different prescribers giving the same class of medication-say, two different ACE inhibitors for high blood pressure. Or worse, a patient gets a new prescription for gabapentin from a neurologist while already taking it for anxiety from their GP.

The problem? Most prescribers don’t have full visibility into what a patient is taking elsewhere. Insurance claims don’t always sync with EHRs. And not all pharmacies share data-unless they’re part of a regional network.

The fix? Use clinical viewers. In Scotland, the NHS Scotland Clinical Viewer gives pharmacists access to prescriptions filled through publicly funded programs across the country. That means if someone gets a 30-day supply of tramadol in Glasgow and shows up in Edinburgh a week later asking for another, you’ll see it. You can flag it. You can call the prescriber. You can protect the patient.

But access alone isn’t enough. Pharmacists must be trained to look for red flags: frequent refills, inconsistent dosing, multiple prescribers, or a patient who always pays cash for certain meds. These aren’t just policy violations-they’re warning signs.

Build a Risk-Based Refill Protocol

Not all medications need the same level of oversight. A nasal steroid? Low risk. A 30-day supply of fentanyl patches? High risk. A smart system treats them differently.

The American Academy of Family Physicians (AAFP) recommends a three-tiered approach:

• Low-risk meds (like antihistamines, nasal sprays): Can be refilled automatically if the patient has been seen in the last 6 months.
• Medium-risk meds (like statins, metformin, beta-blockers): Allow a 3-month supply if the patient has had a follow-up visit and labs are up to date.
• High-risk meds (like opioids, benzodiazepines, stimulants): Require direct provider approval. No exceptions. Even 2 days early is a red flag unless there’s documented proof of loss or travel.

These aren’t just suggestions-they’re safety nets. One UK health system that adopted this model cut early refill requests by 62% in six months. Staff time spent on refill approvals dropped by half. And patient safety improved.

The key? Make it automatic. Use your EHR to flag prescriptions based on risk level. Set up alerts that trigger when a refill is requested too soon. Let your pharmacy techs or nurses handle low-risk refills. Save the doctors for the hard cases.

Use Technology-But Don’t Rely on It Alone

EHRs and e-prescribing systems are powerful tools. But they’re only as good as the data they’re fed. If a patient’s prescription history isn’t fully loaded, the system won’t catch a duplicate. If the prescriber doesn’t document that a refill was picked up early, the next request will slip through.

Here’s what works:

• Enable Drug Utilization Review (DUR) alerts in your pharmacy software. These flag potential duplicates or interactions before you dispense.
• Use electronic prescribing for controlled substances (EPCS). It’s required by law in many places and prevents tampering or forgery.
• Set up automated refill reminders that only trigger after the patient has used at least 75% of their supply. No more "I’m out early" excuses.
• Require prescribers to add notes like "Cancel all prior refills" when issuing new prescriptions. This stops old scripts from auto-renewing.

But tech alone won’t fix human behavior. A pharmacist in Glasgow told me about a patient who came in every month, always on a Tuesday, always asking for the same oxycodone script. The system showed no red flags-until she checked the patient’s pharmacy history across three different towns. Turns out, the patient was getting the same drug from three different clinics. She called the police. The patient was later charged with fraud.

Technology flags patterns. People make the call.

Train Your Team to Speak Up

Too often, pharmacy staff are afraid to say no. They worry about losing a customer. Or they think, "It’s not my job to judge." But safety isn’t optional. Every team member-techs, assistants, pharmacists-needs to know how to respond.

Create a script:

• "I see you’ve picked this up twice in the last 21 days. I need to check with your doctor to make sure this is safe."
• "I can’t refill this early unless there’s a documented medical reason. Can I help you schedule a quick visit?"
• "I noticed you’re taking two medications that work the same way. Let me talk to your prescriber about this."

Practice these responses. Role-play tough conversations. Make it part of your weekly huddle. When staff feel supported, they’re more likely to act.

And don’t forget: patients often don’t realize they’re doing something risky. They think, "My insurance lets me get it 5 days early," or "My doctor said I could refill anytime." Educate them. Leave handouts at the counter. Say it plainly: "We’re not saying no to you. We’re saying yes to your safety."

Work With Prescribers-Not Against Them

The best prevention happens before the prescription is written. If a doctor knows a patient has a history of early refills, they can adjust their approach:

• Prescribe a 90-day supply with no refills-reduces trips to the pharmacy and cuts down on manipulation.
• Use mail-order for chronic meds. Less chance of early refill attempts.
• Set up a "medication agreement" for high-risk patients. It’s not punitive. It’s protective. It says: "I’m here to help you. But I need to know you’re using this safely."

Some practices now schedule refill appointments a week in advance. That way, the patient gets their script on time, the provider stays in control, and no one’s scrambling at the last minute.

When pharmacists and prescribers talk to each other-really talk-the system works. One GP practice in Edinburgh started sending weekly summaries to the local pharmacy: who got refills, who missed appointments, who needed labs. Within three months, early refill requests dropped by 70%. Patient satisfaction went up. No one got left behind.

What to Do When You Catch a Problem

You spot it: duplicate therapy. Early refill. Suspicious behavior. Now what?

Follow this simple checklist:

1. Don’t dispense. Hold the prescription.
2. Check your clinical viewer or pharmacy network for other fills.
3. Call the prescriber. Say: "I’m seeing two prescriptions for the same class of drug. Can we review?"
4. If it’s a controlled substance and the refill is illegal, report it to the DEA’s diversion control division.
5. Document everything: date, time, patient response, what you did, who you contacted.

You’re not accusing. You’re protecting. And you’re not alone. Many states and regions have prescription drug monitoring programs (PDMPs) that let pharmacists check a patient’s history in real time. In the UK, the NHS Scotland PDMP is accessible through the Clinical Viewer. Use it.

Final Thought: This Is About Care, Not Control

Preventing early refills and duplicate therapy isn’t about being strict. It’s about being smart. It’s about recognizing that a patient asking for a refill too soon might be struggling with addiction, forgetfulness, or fear. Or they might just be confused by insurance rules.

Your job isn’t to be the pill police. It’s to be the safety net. The one who notices the pattern. The one who asks the question. The one who calls the doctor before the patient ends up in the ER.

When systems are clear, staff are trained, and technology works with people-not against them-these errors drop. Patients get the care they need. And lives are saved.