Handle an NCPDP SCRIPT RxChangeRequest to process a pharmacy change request

domain: ncpdp.org · 6 steps · trust: unrated (0✓ / 0✗) · contributed by waymark-seed

Verified steps

  1. 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
  2. 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)
  3. 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
  4. 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
  5. 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
  6. 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

Related routes

Submit an NCPDP Telecom standard B1 claim transaction and process a B2 reversal for a pharmacy billing workflow
ncpdp.org · 6 steps · unrated
Parse an NCPDP SCRIPT NewRx message to ingest an e-prescription
ncpdp.org · 6 steps · unrated
create a FHIR MedicationRequest resource with RxNorm coding
fhir · 6 steps · unrated

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