RxChange Message Types Use Cases
A pharmacy sends an RxChange request message to request a change to a new or fillable prescription. Providers who are currently enrolled in the RxChange service level can receive new RxChange request types from the pharmacy. A provider can respond to a RxChange request for the RxChange messages in the .
The RxChange message types use cases are:
- Out of Stock
- A provider can respond to the Out of Stock RxChange request from the pharmacy, and prescribe an alternate medication for the out-of-stock prescription items. This use case is used to request a prescriber to authorize a change to the original prescription if the pharmacy is out of stock of the requested medication.
- Prescriber Authorization
- A provider can respond to the Prescriber Authorization RxChange request from the pharmacy to validate any missing provider information needed for the patient’s prescription. This use case is used to request prescriber authorization information such as confirming their DEA number or enrollment with the prescription benefit plan. The available RxChange Response types for this workflow are Denied and Validated.
- Generic Substitution
- A provider can respond to the existing Generic Substitution request type. The Generic Substitution request type indicates a request to change the medication from brand to generic. You can choose from suggested generic medications and approve one option or deny the change to keep the original prescription valid. Approval sets the new medication as Activein the Medications module and sets the original medication as Inactive. This use case is updated to allow the provider to edit the response before sending it and also dispensing of a generic medication when substitution is not allowed by provider or regulations.
- Prior Authorization
- A provider can respond to the existing Prior Authorization request type, which indicates the pharmacy identifies that prior authorization is needed on a prescription. You can either approve the request and send the Prior Authorization ID (if available) or deny with a reason code of Prior Authorization Denied or Payer Not Contacted. This use case allows a provider to provide ePA approval and denial details for a patient’s prescription.
- Therapeutic Interchange
- The provider can respond to the existing Therapeutic Interchange request type which enables you to approve the medication as it is; choose from suggested medications and modify and approve one option or deny the change to keep the original prescription valid. Approval or approval with changes sets the new medication as Active in the Medications module and sets the original medication as Inactive. This use case is considered as a single use case. Providers can still edit the response before sending it. This use case is used to request a prescriber to authorize a therapy change from the original prescription and includes the workflow where a pharmacy requests a 30-90 day quantity or a formulary change.
- Drug Use Evaluation
- The provider can respond to the existing Drug Use Evaluation request type. The Drug Use Evaluation use case is a part of Therapeutic Interchange. Providers can edit the response before sending it. The use case enables you to request a prescriber to authorize a change to the patient's current medication therapy, such as changing the dosage or prescribing an alternative medication that has fewer, or no, adverse effects than the originally prescribed medications.
- Script Clarification
- The provider can respond to the existing Script Clarification request type. The Script Clarification use case is part of Therapeutic Interchange. Providers can edit the response before sending it. This use case is used to request a prescriber to clarify the original prescription.