Your Pharmacy Was Just Broken Into — Now What?
Picking up the pieces after a break-in might feel like an insurmountable task, but it’s absolutely manageable if you have the right approach. If your pharmacy was broken into, here’s a guide to get you back up and running. For this article, we’ll divide action items into three major categories: legal, safety, and financial.
But before diving into the nuts and bolts, it’s important to step back and acknowledge the stress and emotional toll that break-ins can have (whether it’s your home or your business). If you work for a chain pharmacy or larger organization, your employer might have an Employee Assistance Program to help you and your staff during this time. Many smaller employers might offer this as well. The most important thing is to seek help early and know that you don’t have to face it alone.
Legal considerations
The legal actions you’re required to take are time sensitive, so it’s important to start here.
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The local police
The police should be your first phone call because they will need to collect evidence (your pharmacy is a crime scene now). You’ll also need to work with them to file a police report, which your insurance company will likely ask for.
In this regard, it’s best not to touch anything in the pharmacy until the police get there. If you do, it could become more difficult for them to collect the evidence they need to prosecute the individuals responsible.
DEA
Any theft or loss of controlled substances must be reported to the DEA within one business day using a DEA 106. You must also contact your local DEA Field Office. You can find a directory of offices here.
You’ll of course need to take an inventory to know what’s missing, which can be difficult considering the pharmacy will be a mess. Once you have gathered the medications that were knocked off the shelf, compare your existing inventory to:
The computerized perpetual inventory (for Schedule III-V)
The perpetual inventory log (for Schedule II)
If your computer inventory is not accurate and/or you don’t have a perpetual inventory log, you may have to take a different approach. In that case, start with the following steps:
Pull the last controlled substance inventory
Run purchasing reports since that date
Run dispensing reports since that date
Pull reports of your expired controlled medications
Do the math to determine your expected on-hand quantity:
Add the last inventory to the total amount purchased since that time
Subtract dispensed and expired medications
Yes, that is going to be a pain! If you’re reading this and you have not experienced a break-in, take that as a cue to get your computerized inventory and perpetual inventory logs together. That should be a top priority for any pharmacy.
If there’s any doubt as to whether or not a medication is missing, it is better to assume it is and report it as such. If you find it later, you can always contact the DEA to let them know that line item was found, but at least you have met the reporting requirements.
Board of Pharmacy
Whether it’s a state requirement or not (hint: it probably is), it’s a good idea to contact your BOP. They can help you navigate any state-specific steps you need to take, so let them be a resource for you. For example, they would be a good resource to determine if, or which, medications need to be discarded and which medications are still OK to dispense.
The NABP Directory provides contact information for Boards of Pharmacy in all 50 states, Guam, the Virgin Islands, the District of Columbia, Puerto Rico, the Bahamas, and every province in Canada. For this reason, it’s especially helpful for District Managers and above who are looking to prepare a plan for their states or are responding to multiple break-ins.
Privacy violations
Any break-in will naturally involve privacy violations, and the HHS HIPAA Breach Notification Rule requires you to contact patients and let them know. If the breach could have involved more than 500 patients, you are also required to notify media (typically via a press release). Lastly, you are required to notify the HHS Secretary through their online reporting form.
This is also a good time to mention — don’t post pictures of your will-call area after the break-in on LinkedIn, Reddit, Facebook, or any other social media platforms. Those pictures might contain PHI that can actually be read if the picture is zoomed in.
Safety considerations
In this category, we’ll look at safety considerations for everyone involved: your staff, those coming into your pharmacy in the aftermath, your patients, and you.
Hazardous Drugs
Spilled hazardous drugs, including tablets on the floor, broken vials, and spilled liquids, will need to be cleaned up properly. For guidance, refer to Section V (H) of OSHA’s Controlling Occupational Exposure to Hazardous Drugs (based on ASHP recommendations). Until then, be sure that not only your staff steer clear of that area but also the police department, BOP inspectors, and anyone else who might be involved in the break-in response.
Refrigerated or frozen medications
If the break-in resulted in lost power, you’ll need to determine whether or not your refrigerated medications were exposed to out-of-range temperatures. If so, refer to this article on handling temperature excursions.
Maintaining patient care
Remember, throughout the process your patients need you, too. Here are a few things to consider doing:
Notify local providers you are closed (and for how long). If you have another location (e.g., work for a chain or own an independent with another location), this is a good time to give providers the contact information for that location.
Notify your patients. As with providers, you should provide patients with your alternate location if you have one. If not, it is still best to transfer the prescription out so there isn’t an interruption in therapy. Keep a list, though, of prescriptions you transfer so you can call those patients back once you’re up and running and ask if they would like their prescriptions back at your pharmacy. This will help minimize your lost business.
Change your IVR system. When patients call in, a recording should explain what happened, how long you will be closed, and how they can get their prescriptions filled during that time.
It’s also worth calling your IVR system vendor to find out if there’s any way the IVR system can automate the phone calls to patients. Your IVR or dispensing system might be able to automate provider faxes, which can save you a lot of time as well. If not, there might be outside vendors who can do that for you.
Financial considerations
Once the paperwork and safety concerns are addressed, you’re left facing the financial consequences. Here’s how to protect yourself.
Filing the insurance claim
Hopefully you have business insurance to cover a break-in. If so, you’ll want to contact them soon after it happens to find out what information they need to process your claim. They will most likely want pictures (take plenty, but remember — don’t post them on the internet if they have PHI!) and a copy of the police report.
If you are required to dispose of medications, be sure to include that in the losses (in addition to the property damage).
Protecting financial information
The burglars could have gained access to your financial information, so it’s a good idea to notify your credit card company, your bank, your lender, and any other financial institution you do business with.
If your bank account is frozen or your card numbers changed, notify your vendors who are on auto-pay as well as payers you have set up on direct deposit to prevent any disruptions to your revenue cycle. For direct deposit, the best place to start is your PSAO (if you have one) because central pay, where payment is collected from most payers and then paid to you in one check, is a standard service with most PSAOs.
Reverse distribution
Your reverse distributor is probably not the highest priority, but a good time to call them is after your medication area is cleaned up and you know which medications need to be discarded. They can pay you an extra visit so you don’t have piles of unusable medications laying around, and they might also be able to help ensure you get the most credit possible from the manufacturers.
Taxes
Finally, once the dust has settled and you’ve got the more immediate needs taken care of, you can reach out to your accountant or bookkeeper to find out how the break-in could affect your taxes. While I can’t claim to be an expert in this area, here are some possible tax deductions to think about:
Property damage not covered by insurance
Your insurance deductible
Damaged or unusable medications not covered by insurance (keep in mind, you might need to subtract the credit you get from the reverse distributor to arrive at your net loss)
Damages or unusable front-end inventory not covered by insurance
Lost prescriptions and business from not being open
The bottom line
A pharmacy break-in can be an overwhelming and stressful experience, but there are concrete steps you can take to get back to business quickly. Throughout the process, be sure you are taking care of your staff, your patients, and yourself. If you need help, whether with the logistics or the emotions of it, don’t wait to ask.
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