RxChange Message

Overview

RxChange is a type of message sent by pharmacy to subscriber when the medication should be changed to a different one. It is required that RxChange is preceded by NewRx.

Receiving RxChangeRequest

Once the pharmacy sends an RxChangeRequest, ePrescription module receives Surescripts message at /eprescriptions/rx endpoint and saves it to Aidbox. Resources created:

• MedicationRequest reflecting the incoming data
• DetectedIssue - if only there were some mismatches in related resources
• Provenance - solely as a record that an event has occurred. It is intended to serve as an audit/logging artifact, and should not be relied upon for driving business logic.

There are several ways to track the newly created MedicationRequests:

• Either of Aidbox Subscriptions mechanisms
• Manual/automated tracking based on MedicationRequest modification date and/or status

The ePrescription module creates a DetectedIssue whenever inbound RxRenewal data diverges from existing records; see Detected Issues for the full list of checks and a sample payload.

Supported Request Types

• D: Drug Use Evaluation
• G: Generic Substitution - A modification of the product prescribed to a generic equivalent.
• OS: Pharmacy is out of stock of the medication prescribed and it cannot be obtained in a clinically appropriate timeframe.
• S: Script Clarification
• T: Therapeutic Interchange/Substitution - A modification of the product prescribed to a preferred product choice
• RM: REMS dispensing authorization requirements not met
• U: Prescriber Authorization – Resolution of the prescriber authorization conflict related to state/federal regulatory requirements is required before dispensing.
  • This is the only message type Validated response type can be used for.

Supported Response Types:

Response type is set in http://aidbox.app/ePrescription/FHIRSchema/medication-request-rx-change-decision and can be one of approved, approved-with-changes, denied, pending, and validated:

PATCH /fhir/MedicationRequest/mr1

- op: add
  path: '/extension/-'
  value: { "url": "http://aidbox.app/ePrescription/FHIRSchema/medication-request-rx-change-decision", "valueCode": "approved" }

In case there's a need to change an earlier decision (that wasn't yet sent with /eprescription/rx/respond-to-renewal), you can use a similar patch, but with replace operation:

PATCH /fhir/MedicationRequest/mr1

- op: replace
  # Replace with the index of the necessary extension
  path: '/extension/3'
  value: { "url": "http://aidbox.app/ePrescription/FHIRSchema/medication-request-rx-change-decision", "valueCode": "denied" }

Allowed decisions are:

• approved: Medication change was allowed unaltered.
  • No changes allowed to the stored MedicationRequest and the resources it references.
• approved-with-changes: Medication was allowed with a change to any included resource/field of the MedicationRequest, except the Patient.
  • Uses http://aidbox.app/ePrescription/FHIRSchema/medication-request-rx-change-decision-note as a decision note.
  • It is not recommended to change anything but Medications/MedicationRequest.
• denied: Medication change was denied, medication dispensing should continue as usual.
  • Uses http://aidbox.app/ePrescription/FHIRSchema/medication-request-rx-change-decision-note as a decision note.
• pending: Medication change was put on hold.
  • Uses http://aidbox.app/ePrescription/FHIRSchema/medication-request-rx-change-expected-pended-response-date to store the date until which the decision will be made and re-sent.
  • http://aidbox.app/ePrescription/FHIRSchema/medication-request-rx-change-decision-reason-code is set to Surescripts ReasonCode
  • Uses http://aidbox.app/ePrescription/FHIRSchema/medication-request-rx-change-decision-note as a decision note.
• validated: Can only be used for U request type, alongside denied.

After the response is set, /api/rx/respond-to-change endpoint should be invoked with the ID of the decision-containing MedicationRequest.

POST /eprescription/rx/respond-to-renewal

{
  "medicationRequestId": "mr1"
}