Fraudulent prescriptions: guidance for pharmacists

This resource supports pharmacists in NSW to identify, assess and respond to potentially fraudulent prescriptions for high-risk medicines, including Schedule 8 and Schedule 4D medicines (such as tramadol and paracetamol/codeine combinations). Fraudulent prescriptions may be handwritten, computer generated and hand signed, or electronic (eScripts), and may appear to be issued by a legitimate prescriber. 

All prescriptions for high-risk medicines should be carefully reviewed and validated before dispensing to reduce the risk of patient harm, diversion, and unlawful supply.

While there may be valid reasons for some prescriptions to present with the indicators listed below, the presence of one or more of the following are commonly seen with forged prescriptions and should prompt the pharmacist to apply further scrutiny before dispensing.

• The patient, prescriber, or another pharmacy phones ahead to confirm stock availability.
• The prescription is provided verbally or via fax or email, and inclusion of specialist reports or letters may appear to legitimise the request.
• The prescription is on a non-standard form not consistent with a prescription, such as plain A4 paper, or the layout and formatting of the prescription are inconsistent.
• No eRx barcode is present, or the barcode does not scan correctly.
• There is no corresponding prescribing record for the prescription visible under the patient record in SafeScript NSWopen_in_new (non-handwritten prescriptions).
• Large quantities or multiple PBS pack sizes, or pack sizes that exceed PBS listings, are requested.
• The patient or prescriber is located outside the local area.
• The patient presents after usual business hours and indicates there is an urgent need for the medication to be supplied.

Notes:

• Sophisticated forgeries may include valid PBS authorities (streamlined and phone approval).
• Take extra care with hospital prescriptions where the prescriber may be hard to reach.

If you have concerns about the appropriateness of a prescription or suspect it may be forged, consider the following actions before dispensing:

• Contact the prescriber using contact details obtained from an independent source (not the prescription itself). Be aware that sophisticated forgeries may include false contact information, and not all online or listed medical centres are legitimate.
• Check the prescriber's information on Ahpraopen_in_new.
• Check for published lists of lost, stolen or forged prescriptionsopen_in_new, noting that absence from this list does not guarantee prescription authenticity.
• Check SafeScript NSWopen_in_new, as it may provide valuable information in detecting fraudulent scripts. In addition to the dispensing history, computer-generated and electronic prescriptions will generally appear in the patient profile.
• Speak to the patient to clarify clinical context and presentation.
• If appropriate, confirm the identity of the person collecting the medicine. If a third party is collecting, consider requesting identification and/or evidence of the patient's consent.
• Document all verification steps taken, particularly where concerns remain unresolved.

If you identify or confirm a suspected forged prescription, it is recommended that you:

• Make a copy of the prescription before interacting with the individual.
• Retain the original prescription only if it is safe to do so.
• Report forged prescriptions via the online notification formopen_in_new.
• Notify NSW Policeopen_in_new, noting that this is a legislative requirement.

Schedule 8 medicines: verifying a prescription is mandatory if it is for a new patient and a prescriber you don't know, but it is good practice to do so even if they are known to you. If verification is not possible and there is no reason to suspect the prescription's validity, up to 2 days' supply of the medicine may be dispensed where clinically appropriate to support continuity of patient care.

Always prioritise personal safety and escalate concerns in accordance with local procedures.

Further information 

For more information, refer to L ost, stolen or forged prescriptions. Pharmacists play a critical role in preventing harm associated with fraudulent prescriptions. When in doubt, pause dispensing, verify the prescription, and escalate concerns through established reporting pathways

For more information, refer to Lost, stolen or forged prescriptionsopen_in_new (NSW Health).