How to refuse to fill a prescription tactfully

When a patient brings their prescription to the pharmacy, the prescription doesn’t automatically get filled without question. As a pharmacist, you need to review the details to make sure it is valid and safe to dispense. This process can be hindered if you find the patient is at risk of misusing the drug or experiencing harmful side effects. In several states, pharmacists can even refuse to fill the prescription if they believe dispensing the drug goes against the optimal care of the patient or violates their personal or religious values and beliefs. 

Refusing to fill a prescription is not always straightforward. Many pharmacists may find themselves in a rut on whether they can refuse to fill a prescription. Oftentimes, if not most of the time, the patient won’t be leaving the pharmacy happy if their prescription is rejected. 

So, can a pharmacy refuse to fill a prescription? And, if so, when can a pharmacist refuse to fill a prescription? And beyond that, how do you do it professionally so that the patient stays calm? There are several things to keep in mind when it comes to refusing a prescription. 

Can a pharmacist refuse to fill a prescription?

Refusing to fill a prescription is not against the law. Pharmacists can refuse to fill a prescription for a number of reasons, including:

1. The patient may be abusing or misusing the prescription drug
2. The patient may be trying to fill a prescription too early or in quantities against pharmacy law restrictions
3. The patient may be at risk of adverse effects due to drug interactions or an incorrect dosage
4. The pharmacy no longer has the medication in stock
5. The prescription is completely illegible 
6. The prescription is altered 
7. The prescription is missing required information like the doctor’s signature or strength of the drug
8. You are concerned about other issues

Pharmacists can legally refuse to fill prescriptions due to religious or personal values in most states that have conscience laws. However, some states require that pharmacists avoid neglecting or abandoning the patient’s needs. In other words, you have to ensure the patient is still able to get treated elsewhere if they’re not going to fill the prescription. 

States that allow pharmacists to refuse to fill prescriptions

Pharmacists can refuse to fill prescriptions, but they have to provide some form of patient protection (such as referring them to another pharmacist on duty). These states include:

1. California
2. Delaware
3. New York
4. North Carolina
5. Oregon
6. Pennsylvania

In some states, pharmacists can completely refuse to fill a prescription without having to support the patient in getting their medication elsewhere. These states include:

1. Georgia 
2. Arizona
3. Arkansas
4. Idaho
5. South Dakota
6. Missouri
7. Texas

Other states have laws regarding healthcare providers that may also be applied to pharmacists. These states may have conscience laws with or without patient protections. For example, they may allow pharmacists to reject certain prescriptions and services pertaining to abortion and sterilization. These states include: 

1. Alabama
2. Illinois
3. Maine
4. Nevada
5. New Jersey
6. Washington
7. Wisconsin

This list isn’t comprehensive. Other states may or may not have specific laws for refusing to provide healthcare services (including filling prescriptions). Check with your state to find out what the current legislation entails. 

5 tips for pharmacists on how to refuse to fill a prescription

It can be a challenge to refuse to fill a prescription for a patient who needs their treatment. Saying no can be a stressful experience for both parties, especially if it escalates into an argument. It can take skill and practice to say no to patients in a smooth, non-threatening way.  

1. Try to find a solution

Not every reason for declining a prescription is permanent. For example, if your pharmacy is out of stock, you can offer to transfer the prescription to another pharmacy. Or, if the prescription is illegible, you could ask the patient to request a new one. When you make a good faith effort to help, patients will be appreciative.

2. Be firm

It’s important to acknowledge that it might be difficult for you and the patient if you’re unwilling to fill a prescription. However, you should be firm in saying no to the patient. Briefly and directly explain to the patient why you’re refusing to fill the prescription. Keeping the explanation short and direct leaves no room for debate. For example, you can say, “Unfortunately, I’m uncomfortable filling this prescription.”

3. Stay neutral 

Try not to assume the worst of the patient. Keeping a neutral mindset may help prevent the situation from escalating and let you see everything at face value. You may then be more likely to respond to the patient positively and effectively. 

4. Find a private space

If you’re refusing to fill a prescription for a sensitive reason, you could take the patient to a consultation room, or ask them to step aside to a more private space. That can help to make a conversation more open, and prevent embarrassment—and prevent HIPAA violations.

5. Show empathy

No patient wants to hear that their prescription is being refused. Being empathetic with the patient shows that you understand and can help reassure the patient. You can also build rapport this way so that the patient can trust that you have their best interests in mind. Examples of empathetic statements include, “I see that you’re upset” or “I wish this drug was safe to take with your other medications.”

Most of the time there is a good reason that a prescription can’t be filled, whether the prescription is inappropriate, harmful, or illegal to fill. Refusing to fill a prescription may also be relevant if filling the prescription goes against personal values or beliefs, as long as it’s done within state laws or company policies. Using clear communication and showing empathy can help maintain a strong patient-clinician interaction. 

Patient options when a prescription is refused

If a prescription is refused to be filled because of religious or personal values, the patient can ask that another pharmacist at the store fill the prescription. The patient can also request for their prescription to be returned so they can try to get their prescription filled at a different pharmacy. Patients have other options, such as filing complaints if they feel wronged by the pharmacist. 

Can a pharmacist get sued for not filling a prescription?

Aside from the backlash a pharmacist might receive from the patient, there are other possible outcomes for refusing to fill a prescription. A patient can file complaints with governmental agencies and their state’s Board of Pharmacy. They can make a direct complaint against the pharmacist, the pharmacy store, or the wholesaler, which may result in disciplinary action. 

It is not unlawful to refuse to fill a prescription in most states, but there are cases of patients suing based on different claims. Some patients have claimed that a refusal to fill their prescription violates their civil rights under the Americans with Disabilities Act or the anti-discrimination section of the Affordable Care Act. If a pharmacist speaks to a patient about personal health information that can be easily overheard, the patient can file a HIPAA complaint.

Although a pharmacist might not be breaking state law by refusing a prescription, they might be violating a company policy. For example, in Arizona, a pharmacist refused to fill a hormone prescription drug for a transgender woman. While the pharmacist did not break any state laws, the pharmacist violated a company policy that stated they had to tell the company in advance if religious beliefs would interfere with a patient’s ability to get a medication.