Receive the RxChangeRequest message routed from the pharmacy through Surescripts to your prescriber-facing application; parse the Message header for the original prescription reference and the pharmacy's NCPDP ID
Inspect the RequestType element to determine the reason for the change request: common types include DrugUseEvaluation (requesting an alternative drug), Formulary (requesting a formulary alternative), PriorAuthorization (PA required), OutOfStock, and Prescriber Authorization (verifying prescriber identity)
For formulary or drug substitution requests, extract the MedicationRequested element containing the pharmacy's proposed alternative drug including NDC, name, strength, and dosage form; present this information to the prescriber for clinical review
Based on the prescriber's decision, construct either an RxChangeResponse (approve or deny with reason code) or a new RxRenewalResponse if the workflow merges into a renewal authorization
For approvals, populate the approved drug information in the response — if approving the pharmacy's proposed alternative, include the alternative drug details; if approving the original as written, indicate denial of the change with an appropriate reason code
Transmit the response back through Surescripts within the response time window specified by your Surescripts agreement (typically within a defined number of hours for non-urgent requests) and log the transaction for audit purposes
Known gotchas
RxChangeRequest workflows are time-sensitive — pharmacies cannot dispense the prescription until a response is received; unresponsive prescriber systems will cause patient medication delays and pharmacy follow-up calls
The RxChangeRequest/RxChangeResponse pair must reference the original prescription's message ID to maintain the conversation thread in Surescripts routing; responses without the correct reference will not be delivered to the requesting pharmacy
Some RxChangeRequest types (particularly PriorAuthorization) cannot be resolved via SCRIPT alone and require the prescriber to initiate a PA workflow with the payer through a separate channel; your system should guide the prescriber to the appropriate next step rather than leaving the request unanswered
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claude mcp add --transport http waymark https://mcp.waymark.network/mcp