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

Every month, pharmacists face the same frustrating scenario: a patient walks in two weeks early for a 30-day prescription of oxycodone, claiming their doctor said it was fine. Another patient shows up with two different scripts for the same painkiller from two different doctors. These aren’t just inconveniences-they’re red flags for early refills and duplicate therapy, two of the most dangerous medication errors in community pharmacy today.

According to the CDC, medication misuse contributes to over 12,000 opioid-related deaths annually in the U.S. Many of these cases start with someone getting early refills or stacking prescriptions from multiple providers. Pharmacists are often the last line of defense-but too many still treat refill requests as routine, not clinical decisions.

Why Early Refills Are a Red Flag, Not a Request

Let’s clear up a common myth: just because your insurance lets you refill a 30-day script five days early doesn’t mean you should. That five-day window exists for legitimate reasons-like travel, lost pills, or a pharmacy delay. But patients who do it every month? That’s not a convenience. That’s a pattern.

The DEA strictly prohibits refills on Schedule II drugs like oxycodone, fentanyl, or Adderall. No exceptions. Not even if the patient says, “My doctor wrote it.” Not even if they offer to pay cash. Pharmacists who ignore this risk legal action, license suspension, and worse-helping enable addiction.

One pharmacy in Melbourne reported that 37% of early refill requests for controlled substances came from patients who had already filled the same script at another pharmacy within the last 14 days. That’s not bad luck. That’s drug diversion.

Duplicate Therapy: When Two Prescriptions Do More Harm Than Good

Duplicate therapy happens when a patient gets two or more drugs with the same active ingredient-or drugs that do the same thing. Think: two different brands of ibuprofen, or a prescription for tramadol paired with an over-the-counter cold medicine containing acetaminophen.

The risks? Liver failure from too much acetaminophen. Kidney damage from NSAID stacking. Serotonin syndrome from combining antidepressants and pain meds. These aren’t hypotheticals. A 2022 study in the Journal of Patient Safety found that 1 in 12 medication errors in community pharmacies involved duplicate therapy, and nearly half of those led to hospital visits.

Worse, patients often don’t realize they’re double-dipping. They see two different doctors. They fill one script at Walmart, another at Chemist Warehouse. They assume the pharmacist knows what’s already been prescribed. They’re wrong.

How to Build a Refill Protocol That Actually Works

Randomly checking refill requests won’t cut it. You need a system. The American Academy of Family Physicians (AAFP) developed a simple, proven three-tier protocol that works in real-world settings:

• Low-risk meds (like nasal steroids, thyroid pills): Can be refilled automatically every 90 days if the patient has had a visit in the last 6 months.
• Chronic condition meds (like blood pressure or diabetes drugs): Allow a 90-day supply with one follow-up visit every 3 months. No early refills unless lab results are current.
• Controlled substances: Zero tolerance for early refills. No exceptions unless there’s documented, urgent clinical need-and even then, it requires direct provider approval.

These aren’t suggestions. They’re safety standards. One clinic in Sydney cut early refill requests by 68% after implementing this system. Staff spent less time arguing with patients and more time doing clinical work.

Use Technology-Don’t Just Rely on Memory

Trying to remember every script a patient has filled across five different pharmacies? Impossible. That’s why clinical viewers and state prescription drug monitoring programs (PDMPs) are non-negotiable.

In Australia, the SafeScript system gives pharmacists real-time access to a patient’s controlled substance history across the country. If someone’s filled two oxycodone scripts in the last 10 days? The system flags it. You don’t have to guess. You don’t have to hope. You have data.

Electronic Health Records (EHRs) can help too. Set up alerts in your system to notify you when:

• A patient requests a refill before the expected date.
• A new prescription matches an existing one in their profile.
• A patient has filled the same drug at multiple pharmacies in the last 30 days.

These aren’t fancy features. They’re basic safety tools. If your pharmacy doesn’t have them, ask why.

Train Your Team to Speak Up-Not Just Scan

Pharmacy technicians aren’t just order fillers. They’re frontline safety officers. Train them to recognize the warning signs:

• Patient says, “I need it now-I’m out.” (But they just filled it 10 days ago.)
• Patient insists, “The insurance lets me get it early.” (That’s not how it works.)
• Patient refuses to let you call their prescriber. (Big red flag.)
• Patient is vague about why they need the med. (They don’t know, or they’re lying.)

Empower your staff to say: “I need to check with the pharmacist before I can fill this.” That’s not being difficult. That’s being responsible.

One pharmacy in Adelaide started holding weekly 15-minute huddles where staff reviewed flagged refill requests. Within three months, they identified three patients who were doctor shopping. They reported them to SafeScript. Those patients were referred to addiction services. No overdoses. No arrests. Just better care.

How to Handle the Difficult Patient

Some patients will get angry. They’ll yell. They’ll threaten to go elsewhere. That’s normal. What’s not normal is giving in.

Here’s what to say instead of “I can’t”:

• “I want to make sure you’re getting the safest care possible. Let me check with your doctor to see if we can adjust your prescription.”
• “I see you’ve filled this twice in the last two weeks. Is everything okay? I’m here to help.”
• “I’m required by law to verify this refill. I’ll call your prescriber right now.”

Never say, “The insurance allows it.” That’s not your job. Your job is to protect the patient.

And if the patient refuses to cooperate? Document everything. Call the prescriber. Report to SafeScript. You’re not being a gatekeeper. You’re being a clinician.

What Happens When You Don’t Act

Ignoring early refills and duplicate therapy doesn’t just hurt patients. It hurts your pharmacy.

Pharmacies that fail to monitor refill patterns risk:

• DEA investigations and fines
• Licensing board sanctions
• Loss of insurance contracts
• Reputation damage
• Being named in a lawsuit after an overdose

One community pharmacy in Queensland lost its DEA registration after repeatedly filling early oxycodone refills. The owner was fined $250,000. The pharmacist lost their license. And the patient? They died of an overdose two weeks later.

This isn’t scare tactics. It’s reality.

Make Prevention Part of Your Culture

Preventing early refills and duplicate therapy isn’t about being strict. It’s about being smart.

Start small. Pick one high-risk medication-like a controlled painkiller-and apply your new protocol to it. Track how many early requests you deny. Talk to your team. Celebrate when you catch a potential problem before it becomes a crisis.

Then expand. Add another drug. Then another. Eventually, you’ll have a system that protects patients, reduces stress, and keeps your pharmacy out of legal trouble.

Medication safety isn’t a checklist. It’s a mindset. And if you’re not actively preventing these errors, you’re part of the problem.

If you’re still unsure about a refill request, call the prescriber. Ask: “Is this intended to replace an earlier script?” “Is the patient stable on this dose?” “Are there any monitoring requirements?” You’re not being a burden-you’re being a safeguard.

Medication safety doesn’t happen by accident. It happens because someone-like you-chose to look closer, ask harder, and say no when it mattered.