e-Prescribing: Opportunities Abound

Monday, February 27, 2017

Marsha K. Millonig, MBA, BPharm

I’m already using e-prescribing. What more do I need to know?

Well, there’s more to e-prescribing than just sending or receiving a new prescription or handling refill (renewal) requests. There are many other messages and functions, including:

  • Canceling a prescription
  • Requesting a change to a prescription
  • Notifying the prescriber the prescription has been dispensed
  • Exchanging medication history
  • Requesting prior authorization

Let’s take a deeper dive into each of these and see how they can help you improve patient care, patient satisfaction, and clinician productivity.


When a prescriber discontinues a medication for a patient, the pharmacy is rarely notified. If a patient is enrolled in an auto-refill service, or just forgets to tell the pharmacy to stop filling the prescription, they are at risk for an adverse event.

A recent JAMA Viewpoint, “Responsible e-Prescribing Needs e-Discontinuation,” addresses this issue. The NCPDP SCRIPT Standard, which is used for e-prescribing, supports this critical function via its Cancel messages. The message can be sent when the prescriber discontinues the medication (no additional clicks), and the pharmacy system can use the information to prevent continued fills.


How many times have you gotten a prescription and needed to request it be changed? The hours spent on the phone, leaving messages, playing “phone tag,” are inefficient and frustrating. But again, there’s a way to do this electronically, via the SCRIPT Change messages.

The pharmacy can send a secure message to the prescriber, specifying the requested change (quantity, day supply, product, etc.). The prescriber reviews the request, determines if the change is acceptable, and responds to the pharmacy. The flow is very similar to what occurs today with the Refill messages, yet adoption is limited.

Pharmacies can also use the Change message to notify the prescriber that a prior authorization is needed. (More on that in a bit.)

Fill Status

We all know that medication adherence is an important factor in achieving desired outcomes. Yet, a prescriber may not know until the next patient encounter that the medication he or she prescribed was not dispensed. This could occur for any number of reasons — the patient forgets to pick up the medicine or decides they don’t want to take it. It could also be a cost issue — the patient get to the counter, determines she can’t afford it, and simply walks away. The prescription is returned to stock without any intervention.

There’s a technical solution within the NCPDP SCRIPT Standard — RxFill. Future enhancements to the standard will allow prescribers to indicate when they want to receive this notification, whether for a specific patient, specific prescription, or more broadly.

Medication History

Compiling a complete history on a patient can be challenging. They may not recall all the medications they take (“It’s a little white pill?”) or if they’ve had a specific product.

Reviewing all medications is simply a standard of care for pharmacists and prescribers, beyond any requirements to do so, such as the Joint Commission’s Medication Reconciliation standard. There is a more efficient way to put this list together: the Medication History messages within the SCRIPT Standard. You identify the patient and the date range you’re looking for, send the request, and within seconds, receive the patient’s history from both claims and dispensing records.

Prior Authorization

Prior authorization: Two words that cause angst among healthcare professionals, but a necessary part of the current healthcare system.

Pharmacists have all been there, seeing the words “Prior Authorization Required” on a rejected claim. It means calls to the prescriber’s office, retrying the claim day after day. And for prescribers, it means a lot of busy work — the calls, the search for the right fax form, trying to remember the login for a specific payer’s Web portal.

So, where are the electronic solutions?

We have them! The Change message can be used for the pharmacy to notify the prescriber that PA is needed (or to request a change to a covered product). And within the SCRIPT standard are electronic PA (ePA) transactions that can be used to request a PA, cancel a request, or appeal a determination. Use of these transactions are growing, and the turn-around times are a significant improvement over current processes. Prescribers are seeing responses in seconds or minutes, rather than hours, days, or weeks. These transactions can be used prospectively — before the prescription is sent to the pharmacy — or retrospectively — based on notification from the pharmacy that PA is needed.

Controlled Substances

EPCS, or e-Prescribing of Controlled Substances, is an important tool in the industry’s efforts to manage the nation’s use of controlled substances. Most pharmacies are able to receive these transactions. The greater burden is on prescribers, who must meet certain system and process requirements in order to use EPCS.

When the next version of SCRIPT is named under the Medicare Modernization Act (expected this summer), prescribers, pharmacies, and payers will be able to leverage the latest enhancements to the transactions, only a few of which are discussed here. Yet, the Medicare Modernization Act isn’t the only place where the standard is named. It’s referenced in a variety of state laws, and it’s expected to be named in more states, often focused on EPCS.

As always, talk to your vendors to be sure you are ready to take advantage of all that e-prescribing offers.

Marsha K. Millonig, MBA, BPharm, is president and CEO of Catalyst Enterprises, LLC, and an Associate Fellow at the University of Minnesota College of Pharmacy’s Center for Leading Healthcare Change.

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