Receive the inbound RxRenewalRequest SCRIPT 2017071 message from the pharmacy via Surescripts; parse Header (PrescriberOrderNumber, PharmacyReferenceNumber), Patient, Prescriber, Drug, and RequestedQuantity fields
Route the renewal request to the appropriate prescriber's inbox within the EHR for clinical review; surface original prescription details and any medication history context
Prescriber reviews and selects an action: Approve generates RxRenewalResponse with NewRx transaction attached; ApproveWithChanges generates RxRenewalResponse referencing a modified NewRx; Deny generates RxRenewalResponse with DenialReason coded value
Construct and transmit the RxRenewalResponse within the Surescripts-required response window (check implementation guide for current SLA; historically 48 hours for non-urgent renewals)
If the prescriber does not respond within the SLA, send a DeferredResponse message to notify the pharmacy the request is pending
Log the original RxRenewalRequest MessageID and link it to the RxRenewalResponse for audit and reconciliation
Known gotchas
Some states have specific laws requiring a prescriber to personally review and approve renewals for certain drug classes (e.g., controlled substances, opioids); the routing and approval workflow must enforce these rules and not allow staff auto-approval for restricted drug types
RxRenewalRequest messages can arrive for prescriptions originally issued by a different prescriber in the practice; implement clear routing logic to land the request with the correct authorized provider or a covering provider
Pharmacies may send duplicate renewal requests if no response is received; deduplication on PrescriberOrderNumber and PharmacyReferenceNumber is required to prevent the prescriber from seeing and acting on the same request twice
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