Pharmacy-to-Pharmacy Prescription Transfers, Drug Shortages, and Patient Safety in the Post-DEA Rule Era: A Review of the Literature

Medication access is a critical component of patient safety and effective disease management. Drug shortages, pharmacy operational challenges, and regulatory restrictions can create interruptions in medication availability, forcing patients to transfer prescriptions between community pharmacies. Although prescription transfers are intended to maintain continuity of care, they may introduce medication coverage gaps that delay treatment and increase patient risk. Recent regulatory changes by the Drug Enforcement Administration (DEA) have expanded the ability to electronically transfer Schedule II–V controlled substance prescriptions between pharmacies, potentially reducing barriers to medication access. However, limited research has examined the duration of medication coverage gaps associated with pharmacy-to-pharmacy prescription transfers or identified which medication classes are most vulnerable to interruption. This literature review examines existing evidence regarding drug shortages, medication adherence, patient safety, pharmacy operations, and prescription transfer regulations to evaluate potential risks associated with medication coverage gaps. The review explores how drug shortages contribute to transfer requests, the impact of treatment interruptions on patient outcomes, and the implications of recent regulatory changes. Current literature suggests that medication access disruptions can negatively affect patient safety, increase healthcare costs, and worsen chronic disease outcomes. Despite these findings, significant gaps remain regarding the quantification of transfer-related medication coverage gaps and their effects on high-risk patient populations. Understanding these risks is essential for developing strategies that improve continuity of care and reduce preventable adverse outcomes.