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

Every month, pharmacists face the same frustrating pattern: a patient shows up two weeks early for a refill of oxycodone, another asks for a second prescription of gabapentin from a different doctor, and someone insists their insurance lets them get their blood pressure med five days early-so why can’t they get it now? These aren’t just inconveniences. They’re red flags for early refills and duplicate therapy, two of the most common and dangerous medication errors in community and clinical pharmacy today.

When patients get controlled substances too soon, or take two drugs with the same active ingredient-like taking both Advil and a generic ibuprofen-they’re at risk of overdose, addiction, or harmful side effects. The CDC reports that medication non-adherence contributes to over 125,000 deaths annually in the U.S., and many of those deaths stem from avoidable errors like these. But here’s the truth: most of these mistakes aren’t caused by careless patients. They’re caused by systems that don’t plan for predictable problems.

Why Early Refills Happen-and Why They’re Dangerous

Early refills aren’t always about misuse. Sometimes, a patient loses their pills. Sometimes, they travel and forget to pack them. But when the same person asks for an early refill every month, especially for Schedule II drugs like opioids or stimulants, it’s a pattern. The DEA doesn’t allow refills on Schedule II medications under any circumstances-not even for emergencies. Yet pharmacies still see requests for them, often with excuses like, “My doctor wrote it,” or “I’ll pay cash.”

What makes this worse is that patients often use multiple pharmacies to get around restrictions. One pharmacy might not know the other filled a prescription last week. That’s where duplicate therapy comes in. A patient could be taking metoprolol from their cardiologist and another beta-blocker from their primary care doctor-without either provider knowing. The result? Low blood pressure, dizziness, even heart failure.

According to Pharmacy Times, nearly 30% of early refill requests from controlled substances come from patients who’ve filled similar prescriptions at different locations in the past 30 days. And that’s just what we catch. Many slip through.

How to Stop Duplicate Therapy Before It Starts

The first line of defense? Know what your patient is already taking. That means going beyond your own pharmacy’s records. In many states, pharmacists can access Prescription Drug Monitoring Programs (PDMPs) to see what other pharmacies have dispensed to the patient in the last six months. But not all pharmacists check them regularly.

Here’s what works: make checking the PDMP part of your standard process for every new controlled substance prescription-and for any refill request that comes in early. Don’t wait for a red flag. Make it routine. If you see the same drug filled twice in one month, pause. Ask the patient: “I see you got this last week. Is your doctor aware?”

For non-controlled meds, use clinical viewers if your pharmacy has them. These tools pull in data from publicly funded drug programs and other health systems. A patient on warfarin might have had a recent INR test at a clinic you don’t have records for. Without that info, you might refill their prescription even if their dose needs adjustment.

And never assume that because a patient took a drug before, it’s still safe now. Dr. Ian Stewart, R.Ph., says it plainly: “It cannot be assumed that since the patient has taken the medication previously, a therapeutic assessment is unnecessary.” That’s the mindset shift you need.

Build a Three-Tier Refill Protocol System

Pharmacies that treat refill requests like emergencies are drowning in calls. The solution? Predict them. Plan for them. The American Academy of Family Physicians (AAFP) developed a simple, proven system that breaks medications into three risk levels:

• Low-risk meds (nasal sprays, topical creams, some antidepressants): These can be refilled automatically every 30 days with no provider input. No call needed.
• Medium-risk meds (blood pressure pills, diabetes drugs, thyroid meds): These can be refilled for up to three months-but only if the patient has had a visit or lab test within the last 90 days. If not, the system flags it for a nurse to call and schedule a check-up.
• High-risk meds (opioids, benzodiazepines, stimulants): No automatic refills. Every request requires direct provider approval. And if it’s early? You need documentation of a change in condition.

One health system that implemented this system saw 89% of refill requests handled automatically by staff-without needing the doctor’s signature. That means fewer delays for patients who need their meds, and less burnout for providers.

Use Your EHR to Automate Safety Nets

Your electronic health record (EHR) isn’t just for writing prescriptions. It’s your best tool for preventing errors-if you use it right.

Set up alerts for early refill attempts. If a patient tries to refill a Schedule II drug before 28 days, the system should block it and notify the prescriber. For other meds, configure it to check for duplicates: if a patient has two prescriptions for the same drug from different providers, flag it. Add a note in the chart: “Duplicate therapy detected. Provider notified.”

Also, train your staff to use the “cancel all prior” function when issuing a new prescription. That stops the system from auto-generating refill reminders for the old one. Too many pharmacies still send automated refill reminders for drugs the patient stopped taking-or that were already refilled early.

And don’t forget to document. If a patient gets an early refill because they lost their pills, write it down: “Early refill granted due to loss of medication. Patient counseled on safe storage.” That protects you, the patient, and the system.

Train Your Team to Spot the Red Flags

Pharmacists aren’t the only ones who need training. Your front desk staff, pharmacy techs, and nurses all need to know what to look for.

Common warning signs:

• Patient insists on paying cash for a controlled substance-especially if they’ve had insurance coverage before
• Multiple prescriptions from different doctors, especially for opioids, benzodiazepines, or stimulants
• Early refill requests that happen every month, without explanation
• Patients who say, “My insurance allows it 5 days early,” but the policy actually says “no more than 5 days early for a 30-day supply”-not that they can use the medication 5 days early

Teach your team to respond calmly but firmly. Say: “I understand you need this. Let me check with your doctor to make sure it’s safe to refill early.” That simple phrase gives you time to investigate and protects the patient.

What to Do When You Can’t Refill

Refusing a refill is hard. Patients get angry. Some even threaten to leave. But your job isn’t to make them happy-it’s to keep them safe.

If a patient needs an early refill for a legitimate reason-like travel, hospitalization, or a sudden change in condition-don’t say no. Say: “I can help you with this, but your prescriber needs to confirm it’s safe.” Call the doctor. Email them. Send a secure message. Get it in writing.

For controlled substances, if you suspect misuse, document it. Report it to the PDMP if required. And if the patient is struggling with addiction, don’t just cut them off. Connect them. Say: “I’m concerned about your use of this medication. There are resources that can help. Would you like me to give you a number?”

One pharmacy in Ohio started keeping a list of local addiction specialists and recovery programs. They hand it out-not as a punishment, but as a lifeline. Refill denials dropped by 40% in six months.

Fix the System, Not Just the Symptoms

Early refills and duplicate therapy aren’t just pharmacy problems. They’re system problems. Insurance companies say “5 days early” but patients think they can use the meds 5 days early. Providers don’t communicate with each other. Pharmacies don’t share data.

But you can change that. Start small. Pick one high-risk drug-like oxycodone or alprazolam-and implement a strict protocol for it. Train your team. Use your EHR. Check the PDMP every time. Track how many early refills you deny-and how many patients end up in the ER after you say no.

When you fix the system, you don’t just prevent errors. You build trust. Patients who feel heard and safe are more likely to follow up, to be honest, and to stick with their treatment. And that’s the real win.

What’s Next for Pharmacy Safety?

The future is integrated. More states are linking PDMPs to EHRs. AI tools are starting to flag patterns-like a patient filling opioids in three different cities over six weeks. Health systems are creating centralized refill centers staffed by pharmacists and nurses, so providers aren’t buried in refill requests.

But none of that matters if the person at the counter doesn’t know what to do. Training, protocols, and technology must work together. And it starts with one pharmacist, one decision, one patient at a time.