Understanding the Updated SCRIPT National E-prescribing Standard
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Understanding the Updated SCRIPT National E-prescribing Standard
Understanding the Updated
SCRIPT National E-prescribing
Standard
Wednesday, September 15, 2021
1
The handout for today’s presentation can be found at:
www.nabp.pharmacy/webinar
2
NABP Webinar – September 15, 2021
1
Understanding the Updated SCRIPT National E-prescribing Standard
UNDERSTANDING THE UPDATED SCRIPT
NATIONAL E-PRESCRIBING STANDARD
KEN WHITTEMORE, JR, RPH, MBA
VP, PROFESSIONAL & REGULATORY AFFAIRS
LIVE WEBINAR—SEPTEMBER 15, 2021
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FINANCIAL DISCLOSURE
Ken Whittemore, Jr, declares that, as an employee of Surescripts, LLC, he has a current affiliation or
financial relationship with an organization that may have a direct interest in the subject matter of this
continuing pharmacy education program.
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NABP Webinar – September 15, 2021
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Understanding the Updated SCRIPT National E-prescribing Standard
SCRIPT Standard Background
SCRIPT is a standard created to facilitate the electronic
transfer of prescription data between pharmacists,
prescribers, intermediaries, facilities, and PBM/payers.
• First published in 1997 by NCPDP and updated at least annually
• Medicare Modernization Act (MMA) of 2003 requires that the Secretary of HHS
decide which e‐prescribing standard will be used for Medicare Part D—2006
MMA pilots pointed to NCPDP SCRIPT
• CMS required the industry to move to a new version of SCRIPT on January 1,
2020, which is known as Version 2017071 (the previous version of SCRIPT known
as Version 10.6 had been in use since 2013)
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SCRIPT VERSION 2017071 (1) Incorporated new or
enhanced data
segments, elements,
HAS UPDATED and codes to existing
messages
E-PRESCRIBING IN TWO
(2) Added new message
BASIC WAYS types that allow the
exchange of
information not
contemplated when
SCRIPT was first
created
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NABP Webinar – September 15, 2021
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Understanding the Updated SCRIPT National E-prescribing Standard
WHAT’S CHANGED?
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WHAT CHANGED: SCRIPT 2017071 –
Patient
Topic Brief Description
Allergies Patient’s allergies can be sent via eRx
Patient
Attributes
Former Name Patient’s former (e.g., Maiden) name may be included in the eRx
International Address XML schema updated to accommodate international addresses
Non‐Humans (Pets) Species can be indicated on eRx, e.g., Canine, Bovine, Feline
Primary Language Patient’s preferred language can be indicated if non‐English
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Understanding the Updated SCRIPT National E-prescribing Standard
WHAT CHANGED: SCRIPT 2017071 –
Prescriber
Topic Brief Description
Mid‐level practitioner Certificate To Prescribe may be sent in
Certificate to Prescribe
Prescriber applicable states/jurisdictions
Attributes Prohibit Refill Requests &
Prescribers may indicate that they do not want Renewal Requests
and also designate an alternate prescriber for follow‐up (e.g.,
Follow‐Up Prescriber
Urgent Care, ERs)
Prescriber’s former (e.g., Maiden) name may be included
Former Name
in the eRx
Prescriber Identifiers Additional prescriber license numbers may be sent in eRx
Practice Location Segment Prescriber’s Practice location may now be sent (e.g., telemedicine)
Veterinarians Veterinary prescribers now able to send eRx
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WHAT CHANGED: SCRIPT 2017071 –
Prescription
Topic Brief Description
1000‐Character Sig (!) The Directions field has been expanded to 1,000 characters
Prescription
Attributes Proactive approval documentation for pharmacist administration of
Authorization to Administer
medications (e.g., immunizations)
Updated indicator for Brand Medically Necessary that is compliant
Brand Medically Necessary
with CMS guidelines
Standardized messages to patients – such as “Needs Appointment” –
Codified Notes
now sent in codified format
Up to 25 individual ingredients and quantities now available on eRx
Compounds (!)
for compounds
Delivery Prescribers may indicate patient preference for delivery
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Understanding the Updated SCRIPT National E-prescribing Standard
WHAT CHANGED: SCRIPT 2017071 –
Prescription (cont.)
Topic Brief Description
Insurance Updates (COO
Realignment/streamlining of third‐party payer‐related info
Prescription Segment)
Attributes Follow‐up reminders for pending requests may now be sent
Electronic Follow‐Up
electronically
Prescribers may indicate multiple prescription vials required for
Home & School Use
home and school use
Substance Use Patient’s social history for substance use may now be sent via eRx
Urgent Rx Prescribers may request expedited processing for a prescription
The size of a wound may now be sent to assist pharmacist with
Wound Information
appropriate package size selection
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WHAT CHANGED: SCRIPT 2017071 –
Prescription (cont.)
Topic Brief Description
Additional information needed for Medicare billing of diabetic
Diabetic Testing Supplies
Prescription testing supplies now sent on eRx
Attributes Do Not Fill
Prescribers may indicate a prescription should not be filled for
cover prescriptions, drug‐to‐drug interactions, or hold for patient
request.
Flavoring Indicator Prescribers may proactively authorize medication flavoring
Office of Pharmacy Affairs ID Enhanced support for 340B information on eRx
Order Grouping Prescriptions may now be grouped together (such as #1 of 3)
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6Understanding the Updated SCRIPT National E-prescribing Standard
RXCHANGE
• BIDIRECTIONAL COMMUNICATION BETWEEN PHARMACISTS AND PRESCRIBERS
• NOT NEW, BUT HAS BEEN EXPANDED
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PROCESS STEPS: MAIN USE CASE
1. The pharmacist
sends an 2. The Surescripts 3. The prescribing 4. The prescriber
RxChange to the Network validates system returns a responds either
prescriber to the message and verify message to approving or
request a change sends to the confirm the receipt denying the
to a fillable prescriber system. of the RxChange change
prescription.
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7Understanding the Updated SCRIPT National E-prescribing Standard
SCRIPT 2017071 EXPANDS THE RXCHANGE USE CASES
Generic
Substitution
Generic Prior
Substitution Authorization
Version 10.6
Therapeutic
Version 2017071
Interchange
Prior
Authorization
Drug Use
Evaluation
Therapeutic Script
Interchange Clarification
Out of Stock
Prescriber
Authorization
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CANCELRX
• PRESCRIBER TO PHARMACIST
• NOT NEW, BUT USE IS GROWING DUE TO PRESCRIBER INTEREST & CONCERNS
(SEE “UNDERUSE OF ELECTRONIC HEALTH RECORD FEATURES—THE CASE FOR
CANCELRX,” JAMA INTERNAL MEDICINE ONLINE, AUGUST 30,2021)
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CANCELRX WORKFLOW
CancelRx is sent from prescriber’s system to a pharmacist’s system to:
• Discontinue an active prescription with additional fills remaining, OR
• Cancel a prescription that has not been filled.
CancelRx Response is sent from pharmacist’s system to prescriber’s system
to acknowledge or reject the CancelRx (due to inability to match).
CancelRx
EHR CancelRxResponse PHARMACY
SYSTEM SYSTEM
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RXCHANGE & CANCELRX
ENABLEMENT
RxChange CancelRx
Pharmacies Pharmacies
• Enabled = 70% • Enabled = 85%
• Active = 28% • Active = 80%
Prescribers Prescribers
• Enabled = 52% • Enabled = 72%
• Active = 24% • Active = 44%
Current as of August 2021
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9Understanding the Updated SCRIPT National E-prescribing Standard
WHAT’S NEW?
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NEW SCRIPT
MESSAGE
NewRx-
Request
TYPES RxTransfer
Plus
LTPAC,
REMS, and
P/A
These new SCRIPT messages are optional at this
time, so they haven’t yet been implemented by all
health information technology vendors
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NEWRX REQUEST
• PHARMACIST TO PRESCRIBER MESSAGE
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NEWRX REQUEST
Function
Use Case Examples
• Pharmacist to prescriber
• Allows a pharmacist to send a • New therapy
request for a new prescription • Patient goes to new pharmacy
• Prescriber responds with either a • Never filled and expired
NewRx or a denial • Regularly gets refills but expired
• Original pharmacy closed
Value
• Patient satisfaction – directly
address patient need/request
• Eliminate manual workflows at
pharmacy (call or fax from
pharmacist to prescriber)
• Improved adherence
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11Understanding the Updated SCRIPT National E-prescribing Standard
RXTRANSFER
• BIDIRECTIONAL MESSAGES BETWEEN PHARMACISTS/PHARMACIES
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RXTRANSFER
Function Use Case Examples
• Pharmacist to pharmacist • Patient moved/on vacation
• Pharmacist requests the transfer of • Patient went to incorrect location
a prescription (i.e., “pulls” the eRx; • Change in patient preference
a “push” option is in development) • Medication out of stock
• Provides an “ALL” Option
Value
• Satisfy the patient – directly
address patient need/request
• Provides significant
improvements in the efficiency
and accuracy of the transfers of
prescriptions
• Minimizes manual workflows at
pharmacy (call or fax from
pharmacy to pharmacy)
• Method to forward a C-II
medication in certain situations
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12Understanding the Updated SCRIPT National E-prescribing Standard
• “Pull” contrasted with “push”
use cases
RXTRANSFER • Telephone contact between
pharmacists might still be
necessary
NUANCES • Suitability for transfers of e-
prescriptions for controlled
substances
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• Pharmacist and
REMINDER: prescriber end-user
requests to pharmacy
THE NEWRX REQUEST & RXTRANSFER technology and
MESSAGES ARE OPTIONAL, SO NOT ALL electronic health
record (EHR) vendors
VENDORS HAVE IMPLEMENTED THEM are therefore very
important
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CPE BONUS…
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BONUS IN-DEPTH
INFORMATION
(PLUS, CPE CREDIT!)
For those interested in
more information on the
industry’s transition to the
new version of SCRIPT, a
continuing pharmacy
education (CPE) article
was published in the
November 2019 issue of the
National Community
Pharmacists Association’s
(NCPA) monthly journal,
America’s Pharmacist. CPE
credit is available for
reviewing this article
through November 1, 2022.
The article is attached at
the end of this handout.
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14Understanding the Updated SCRIPT National E-prescribing Standard
SELF-ASSESSMENT QUESTIONS
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QUESTION #1
The health information technology industry (HIT) moves to a new version of the NCPDP SCRIPT
Standard when:
a. NCPDP’s staff has decided that the time has come.
b. The Secretary of HHS adopts a new SCRIPT version via CMS rulemaking.
c. A sufficient number of prescriber and pharmacy HIT end users petition Congress.
d. None of the above.
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NABP Webinar – September 15, 2021
15Understanding the Updated SCRIPT National E-prescribing Standard
QUESTION #2
NCPDP SCRIPT Version 2017071 has updated the e-prescribing process by:
a. Incorporating new or enhanced features to existing message types.
b. Adding new message types to meet previously unrecognized needs.
c. Deleting several message types to make room for expanded e-prescribing functionalities.
d. Both a. and b. are correct.
e. Both b. and c. are correct.
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QUESTION #3
Which of the following is not true regarding SCRIPT 2017071:
a. RxChange and CancelRx messages are new with this version.
b. NewRx Requests and RxTransfer messages are new with this version.
c. Some e-prescribing message types are not mandatory for e-prescribing participants.
d. Two of its most significant improvements are the expanded Sig field and the ability to transmit
compounded prescription information.
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NABP Webinar – September 15, 2021
16Understanding the Updated SCRIPT National E-prescribing Standard
SURESCRIPTS QUERY • Increasingly, we are being
approached by entities
FOR ATTENDEES calling themselves “non-
dispensing pharmacies” or
“hubs” that want to
connect to our network.
• Workflows and business
models vary, but all want to
be involved in the flow of
prescriptions between
We’re very interested in your perspective if prescribers and pharmacies.
you have one. • Neither appear to be
Ken.Whittemore@Surescripts.com mentioned specifically in
most pharmacy board rules.
• Always striving for regulatory
compliance, we’re
generally unsure how to
respond to such requests.
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QUESTIONS?
KEN.WHITTEMORE@SURESCRIPTS.COM
(REGULATORY IS IN MY TITLE, SO FEEL FREE TO PING ME ANYTIME)
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NABP Webinar – September 15, 2021
17Understanding the Updated SCRIPT National E-prescribing Standard
NABP® and NABP
Submit Your CPE Claim Foundation® are accredited
by the Accreditation Council
for Pharmacy Accreditation
(ACPE) as providers of
1. Claim your CPE credit by signing in to NABP’s submission site: continuing pharmacy
https://nabp.pharmacy/claimcpe (case-sensitive) education (CPE). ACPE
provider number: 0205.
2. Select the webinar from the Live Meetings and Conferences section
3. Enter the session code that was provided at the end of the webinar
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18A giant leap: The industry
CONTINUING
adopts a new version of
the national e-prescribing
EDUCATION
standard
by Lisa Schwartz, PharmD, RPh;
and Ken Whittemore, Jr., RPh, MBA
Nov. 1, 2019 (expires Nov. 1, 2022)
Activity Type: Knowledge-based
To earn continuing education credit:
ACPE UAN: 0207-0000-19-398-H04-P;
ACPE UAN: 0207-0000-19-398-H04-T
Upon successful completion of this article, the pharmacist should be
able to:
1. Discuss how the adoption of a new, updated version and the effective
date of the national NCPDP SCRIPT e-prescribing standard is deter-
mined.
2. Discuss policy and operational aspects that led to rapid growth in
e-prescribing volume between 2008-2018.
3. List the new messages in NCPDP SCRIPT 2017071 and several of the
data elements or codes that will improve data exchange between pre-
scribers and pharmacists.
4. Explain the role of independent pharmacies in adopting the full range
of messages available
FREE ONLINE CE. To take advantage
Upon successful completion of this article, the pharmacy technician of free continuing pharmacy educa-
should be able to: tion (CPE) for this program, pharma-
1. Discuss how the adoption of a new, updated version and the effective cists and pharmacy technicians must
date of the national NCPDP SCRIPT e-prescribing standard is deter- achieve a passing score of 70% on
mined. the online continuing education quiz
2. Discuss policy and operational aspects that led to rapid growth in for the program. If a passing score is
e-prescribing volume between 2008-2018. not achieved, one free reexamination
3. List the new messages in NCPDP SCRIPT 2017071 and several of the is permitted. To take this test, go to
data elements or codes that will improve data exchange between pre- www.ncpalearn.org. This activity is
scribers and pharmacists. listed under Online Activities. If you
4. Explain the role of independent pharmacies in adopting the full range have not registered with this site,
of messages available you must do so before being able to
access the CE Center. You will receive
immediate online test results and
credits will be posted to CPE Monitor
NCPA® is accredited by the Accreditation Council for Pharmacy Education as a provider within six weeks. To obtain your CPE
of continuing pharmacy education. NCPA has assigned 1.5 contact hours (0.15 CEU) of
continuing education credit to this article. Eligibility to receive continuing education credit Monitor e-Profile ID, please go to
for this article expires three years from the month published. www.cpemonitor.com to register.
www.ncpanet.org/ap 43
19STANDARDS … WHO NEEDS THEM? WHY SO LONG BETWEEN UPDATES?
As it turns out, in this modern world, everyone does. The members of NCPDP, which includes representatives
They are found everywhere, though most people are from the pharmacy profession, are constantly working
probably unaware of their existence. For example, how to make sure that SCRIPT is a complete and responsive
is it that you can buy light bulbs from dozens of different standard for e-prescribing and related messages that
manufacturers and they all easily fit in your fixtures at meets the varied professional and business needs of
home? Because there is a national standard that speci- all users (please see Table 1). You can just imagine the
fies the width, the length, and what the thread pitch on number of changes packed into an update when the past
a light bulb should be. What about tires? How is it that seven years have seen rapid adoption of e-prescribing
a variety of tires can fit on countless different vehicles? due to prescriber use incentives, new data requirements
Standards. Compact discs and DVDs can be played on to improve patient care, and a preference for codes in-
many different types of hardware. Why? Standards. You stead of free text to streamline and improve automation.
can send emails, texts, photos, and videos back and This said, somewhat incongruously, it is not really up to
forth with ease between cellphones, tablets, laptops, and NCPDP or its members to decide when the industry will
personal computers all because of information technolo- move to a new version of SCRIPT. Instead, it is actual-
gy standards. And, since 1997, there has been a national ly the Centers for Medicare & Medicaid Services that
standard available to transmit prescriptions electronical- makes this decision.
ly from prescribers to pharmacies in the U.S.
Why is CMS in charge when it comes to deciding which
So what does the national e-prescribing standard look version of SCRIPT the industry will use? You have to
like? Well, it’s pretty complicated — probably far more go all the way back to 2003, when the Medicare
complicated than most pharmacists or pharmacy techni- Modernization Act — also known as Medicare Part D
cians would imagine. After all, the information required — was enacted. Among the 400 plus pages of the
to be included in prescriptions by most state boards of MMA, one section on one page gave the Department
pharmacy and the federal Drug Enforcement Administra- of Health and Human Services secretary the respon-
tion consists of the following: sibility for determining which e-prescribing standards
• The patient’s name and address. should be used for Medicare Part D. Given the size of
• Drug name, strength, and form. that program, this effectively means that HHS, through
• Directions for use, such as the sig. CMS, determines which e-prescribing standard is used
• Number of refills, if any. nationwide. Most recently, in April 2018, in response to
• The prescriber’s name, address, and license the industry’s petitions, CMS published a final rule that
number(s). gave the industry until Jan. 1, 2020, to move to SCRIPT
2017071, which is what the entire industry is now
Yes, on occasion, regulatory authorities require a bit more focused upon. (Interestingly, SCRIPT is not the named
than those bullet points on prescriptions, but not to the standard in the Part D program for electronic prior
extent that it would require several hundred data fields to authorization, or ePA, which helps explain why ePA
transmit the information. Yet that is easily the number of solutions have had a harder time in terms of adoption
fields that make up just the new prescription portion of and utilization.)
the national e-prescribing standard known as SCRIPT.
SCRIPT — which is capitalized but isn’t an acronym — is
the backbone of nationwide e-prescribing. It is a stan- Table 1: Examples of related messages
dardized set of data elements and codes developed and
maintained by the members of the National Council for
Prescription Drug Programs, or NCPDP. Another way to Prescriber-initiated: Pharmacy-initiated:
say it is that there is a group of people from all sides of • Cancel Rx • NewRx request
the e-prescribing world that developed a big set of form • Census • RxChange request
fields and preselected codes used to quickly and accu- • Drug administration • Cancel Rx response
rately fill in an electronic form. The currently adopted • Recertification • Rx fill
version of this standard is known as NCPDP SCRIPT • Resupply • Rx renewal request
Version 10.6, but on Jan. 1, 2020, the industry will be • Rx change response • RxTransfer
adopting the first update in almost seven years • Rx renewal response
by moving to NCPDP SCRIPT Version 2017071.
44 America’s PHARMACIST | November 2019
20A BRIEF HISTORY OF E-PRESCRIBING permitted until 2010, when the DEA published rules permit-
To promote a baseline level of understanding of e-pre- ting it, and after that about half of the states had to revise
scribing before getting into the substantial upgrades their statutes and/or regulations to align with those of the
included in SCRIPT 2017071, let’s review the 20-plus DEA to allow EPCS. This delay in regulatory authorization
years the standard has been available. After a relatively has meant that at this time slightly fewer pharmacies are
slow first decade, in 2009, Congress enacted MIPPA — able to accept EPCSs, and prescribers in states without
the Medicare Improvements for Patients and Providers active EPCS mandate laws lag significantly behind in the
Act — which offered modest financial enticements for adoption of EPCS (see Table 2). In response, both states
providers to adopt and utilize e-prescribing. Not long and the federal government are adopting rules that require
thereafter, adoption took a giant leap forward after the prescribers to adopt e-prescribing. Specifically, 28 states
enactment of the Health Information Technology for have now enacted legislation that will require e-prescribing
Economic and Clinical Health Act, which offered huge across the board, e-prescribing for all controlled substances,
incentives for prescribers to adopt electronic health re- or e-prescribing for just a subset of controlled substances,
cords. All such EHRs were required to include an e-pre- such as opioids. On the federal side, the SUPPORT for
scribing functionality. HITECH’s goal was to encourage Patients and Communities Act of 2018 includes a mandate
electronic health information exchange, but the rush that prescriptions for controlled substances billed to
to comply with the program’s numerous certification Medicare must be prescribed electronically by Jan. 1, 2021.
requirements translated into some EHR systems being
poorly designed and implemented, the results of which WINTER IS COMING … BUT FOR PHARMACIES
were often felt downstream in community pharmacies. RECEIVING E-PRESCRIPTIONS, IT’S A GOOD
Over the past several years, critical performance im- THING
provement efforts have been directed at correcting such Let’s now return to the primary subject at hand — the
deficiencies and perfecting the e-prescribing process. aforementioned January 2020 industry move to the new
version of the national e-prescribing standard known as
Today, 98 percent of pharmacies and 76 percent of pre- SCRIPT 2017071. Broadly, the enhancements brought to
scribers have adopted e-prescribing in general, and 96 per- bear by this version fall into two categories:
cent of pharmacies and 40 percent of prescribers are now • The incorporation of new data segments, elements,
enabled for e-prescribing for controlled substance drugs. and codes to existing messages such as new
E-prescribing for controlled substances, or EPCS, was not prescriptions (NewRx).
Table 2: Electronic Prescribing requirements NOW EXIST IN 28 STATES (07/17/2019)
All prescription electronic
requirement in effect
All prescription electronic
requirement in future
All EPCS requirement in effect L
All EPCS requirement in future
EPCS subset requirement
(e.g., opioids) in effect
EPCS subset requirement
(e.g., opioids) in future
EHR EPCS adoption requirement
eRx/EPCS legislation in progress (L)
Copyright © 2019 by Surescripts, LLC.
All rights reserved. Note: CO and MO requirements exclude Schedule V.
www.ncpanet.org/ap 45
21• The addition of new messages that allow the ex- As was mentioned previously, there are many addition-
change of information not originally contemplated al improvements contained in the new e-prescribing
by SCRIPT, such as the ability to transfer electronic standard, so let’s touch on several more examples
prescription information between pharmacies (Rx- from among the hundreds of changes made in SCRIPT
Transfer). 2017071 in the form of a “lighting round:”
• Allergies: A patient’s allergies can be sent using
All told, SCRIPT 2017071 makes hundreds of improve- SNOMED codes.
ments to the e-prescribing process, but most of them are • Brand medically necessary: This data element is
not likely of day-to-day interest to pharmacy personnel. being updated to meet CMS guidelines.
Thus, for the purposes of this discussion, the focus will • Codified notes: A brief list of standardized notes,
be on changes that most directly and significantly affect such as “Needs Appointment,” is being added.
pharmacy practice, some of which pharmacists and • Do not fill: Prescribers may indicate that the
pharmacy technicians have been wishing would happen prescription should not be filled because it is a
for some time. cover prescription or should be kept on file until the
patient requests it.
It might be going out on a limb a bit, but experience • International address: A country code will be
suggests that the first SCRIPT upgrade that should be available to support international addresses.
mentioned is that the new standard is designed to ac- • Prescriber identifiers: Additional fields are being
commodate the electronic prescribing of compounded added to accommodate multiple prescriber
prescriptions. None of the earlier versions of SCRIPT identifiers, such as DATA 2000/NADEAN (the ‘X’
were designed to convey information about compounded DEA number).
prescriptions, but as many pharmacists and pharmacy • Primary language: The patient’s preferred language
technicians have experienced, prescribers have often can be indicated if other than English, which is use-
tried to shoehorn such information into electronic pre- ful in general and is a requirement in some states.
scriptions anyway, leading to much confusion among • Prohibit refill requests & follow-up prescriber
those receiving such prescriptions. This should no lon- information: Prescribers may indicate that they do
ger happen after January 2020, because the new version not want to receive renewal requests (such as in
of SCRIPT is able to incorporate the drug name and the case of emergency rooms or urgent care) and/or
quantity for up to 25 different ingredients in one electron- they can designate an alternate prescriber for
ic prescription. And if all else fails, for the applications follow up.
that support it, the compounding pharmacy can request • Substance use: If applicable, the patient’s sub-
a new prescription. stance abuse history can be shared with pharmacy
personnel.
Another component of electronic prescriptions that has • Urgent Rx: Allows a prescriber to request expedited
been problematic for pharmacy personnel over the dispensing of a particular prescription.
years is the sig, or patient instructions, field. All previous • Weight: Not new, but frequently requested, a
versions of SCRIPT have limited the length of this field patient’s weight can be sent in kilograms in the
to 140 characters, which in many cases was insufficient “Observation” field.
for prescribers to express their instructions to patients
as they wished. This, too, often led to confusion and All of these examples are considered to be of special
delays in pharmacies, requiring pharmacy personnel to interest to pharmacy personnel, but please be advised
reach out to prescribers to clarify what they meant. To that this list represents only a small portion of what is in
address this e-prescribing challenge, NCPDP members store in the new version of the e-prescribing standard.
approved a sig field expansion to 1,000 characters
in SCRIPT 2017071. Hopefully there will be very few Now let’s look at just a couple of the entirely new
instances in which a prescriber will actually use all 1,000 messages being introduced in SCRIPT 2017071. As was
characters available to write a sig, because that would mentioned earlier, these messages deal with unmet
cause a different type of problem at the pharmacy end needs that earlier versions of the e-prescribing standard
(think about trying to fit all of that on a prescription did not anticipate:
label!), but the added capacity should definitely resolve • RxTransfer: This message is exactly what you
more issues than it causes. It also is anticipated that would think from its name — it’s an electronic way
pharmacy software vendors will devise methods of han- to perform the age-old procedure of transferring a
dling sigs that are toward the higher end of this new limit. patient’s prescription from one pharmacy to another.
46 America’s PHARMACIST | November 2019
22Frankly, it is a little surprising that NCPDP didn’t it to another pharmacy at the patient’s request. This
tackle this need earlier, but the oversight will be is not possible with the version of RxTransfer that
corrected soon. currently is being adopted. Once the pharmacy that
From a workflow standpoint, RxTransfer is modeled originally dispensed the prescription receives the
on the current process in that the pharmacy where transfer request, it will send a response with the
the patient would like to have his or her prescription prescription information or a response denying the
filled initiates a message to “pull” the prescription request (such as the prescription was already trans-
from the pharmacy that originally dispensed it. It is ferred, no refills remain, or the prescription was not
important to understand this point, because there found).
are some in the industry who have the mistaken Additionally, unlike other e-prescribing messages,
impression that RxTransfer can also be used as a this communication takes place solely between
“push” message, meaning the pharmacy that orig- pharmacies, which means that both the receiving
inally dispensed a prescription can simply forward and sending pharmacies must be enabled to handle
An underutilized e-prescribing message becomes more muscular
There are multiple reasons why a pharmacist might want to suggest that a prescriber make a change in a patient’s
prescription, and traditionally such recommendations have been made in verbal or paper form. For many years, however,
there has been an electronic message available for transmission via the e-prescribing infrastructure that can convey
change recommendations from pharmacists to prescribers. This message is called RxChange, and thus far the pharmacy
community has not taken advantage of its functionality to the degree that you might expect. SCRIPT 2017071 significantly
expands the number of circumstances in which this message can be used, though, so it is hoped that dramatic increases
in the use of this message will be noted in the future.
Presently, there are three uses cases available for RxChange:
•G
eneric substitution: This is suitable when a new generic becomes available during ongoing treatment, the prescriber
has indicated dispense as written but the patient still wants a generic, a brand is not covered, a high copay or coinsurance
makes the brand unaffordable, the patient desires a biosimilar that requires prescriber authorization, or the pharmacy
does not carry a specific product.
•P
rior authorization: It’s used when a pharmacy receives a prescription claim reject indicating that a prior authorization
number is needed from the prescriber before the prescription will be covered by a patient’s insurance.
•T
herapeutic interchange: It’s appropriate whenever a pharmacist determines a change in therapy would benefit the
patient.
These are beneficial to be sure, but the industry has added several more valuable use cases in the new version of
SCRIPT:
•D
rug use evaluation: This is applicable when a pharmacist determines there are alternative drugs that could be
dispensed with fewer adverse effects.
•S
cript clarification: This is employed when a pharmacist or pharmacy technician needs clarification to the medication
information contained in a prescription to be able to dispense it.
•O
ut of stock: The pharmacy does not have any of the medication in stock and does not anticipate it will obtain it soon
enough for the patient.
•P
rescriber authorization: This is useful when the pharmacist wishes to confirm the prescriber’s authority to prescribe
(a limited use case).
Judging by feedback that has been received from pharmacy personnel over the years, script clarification might end up being
the most helpful of all of the new RxChange use cases. Pharmacy owners and managers interested in using RxChange for
this new purpose should reach out to their pharmacy software vendor to ensure that this new feature is going to be made
available to them with their SCRIPT 2017071 update.
www.ncpanet.org/ap 47
23RxTransfer messages. For this to happen, pharma- and e-prescribing intermediaries have been preparing
cy software vendors must incorporate RxTransfer intently for more than a year for CMS’s Jan. 1, 2020
message capabilities into their applications. Phar- deadline, and most industry participants should be ready
macy owners and managers who have an interest in for the cutover on that date. It is hoped that by sharing
using RxTransfer messages should therefore have a information in this article on the most noteworthy new
conversation with their pharmacy software vendors features to be delivered by SCRIPT 2017071, practicing
sharing their interest. Finally, pharmacists must con- pharmacists and pharmacy technicians will come to
sider whether such electronic prescription transfers understand the importance of this critical transition and
are allowed by their state’s laws and regulations. will be encouraged to do what they can to participate in
NewRxRequest: This, too, is a message designed
• the process and fully utilize the new and/or enhanced
to attend to a previously unmet need, although this technological tools that they will be given. ■
type of communication is not as commonplace as
transferring prescriptions. It allows a pharmacist to Lisa Schwartz is NCPA senior director, professional affairs.
request a new prescription from a prescriber with ei- Ken Whittemore is Surescripts vice president of professional
ther minimal information or expired prescription in- and regulatory affairs. Questions of a technical nature should be
formation. For example, a patient might come to the sent to Whittemore at ken.whittemore@surescripts.com.
pharmacy saying that his or her physician was going Other questions may be sent to lschwartz@ncpanet.org.
to send a prescription for an antibiotic to the phar-
macy, but no such prescription is in the pharmacy’s
records. In this case, a NewRxRequest can be sent
to the prescriber indicating simply that the patient
has requested an antibiotic, and then the prescriber
can respond as they see fit. Another possible use
for this transaction is related to prescriptions for
which patients have an ongoing — yet very intermit-
tent — need, such as allergy medications or asthma
inhalers. If a patient’s prescription is too old, or the
information about the prescription is incomplete, a
NewRxRequest will probably be the best choice to
attempt to attend to the patient’s medication need.
Again, similar to the data elements mentioned earlier,
these are just two out of the 10 new messages made avail-
able by SCRIPT 2017071, but they are likely the ones that
will be of the greatest interest to pharmacy personnel.
TAKING ADVANTAGE OF ALL THAT SCRIPT
2017071 HAS TO OFFER
The adoption and utilization of e-prescribing over the
past two decades has delivered on much of the technol-
ogy’s promise of increased accuracy and safety, greater
pharmacy and prescriber efficiencies, more robust
communication between medical professionals, and
reduced costs. This said, as is the case with virtually
every modern technology, regular updates are critical to
maintaining relevance, delivering enhanced capabilities,
and yes, remediating deficiencies and imperfections.
Because the industry is constrained by federal require-
ments in terms of how often it can move to new versions
of the SCRIPT standard, it is that much more important
that maximum utility and value are wrung out of every
upgrade. EHR vendors, pharmacy software vendors,
48 America’s PHARMACIST | November 2019
24CE
QUIZ
Continuing Education Quiz 7. Which federal legislation was most responsible for
Select the correct answer. stimulating the adoption of e-prescribing in the U.S.?
a. Health Information Technology for Economic and
1. The SCRIPT standard is used to transfer data between Clinical Health Act
which of the following: b. Medicare Improvements for Patients and Providers Act
a. Prescribers and pharmacies c. SUPPORT Act for Patients and Communities of 2018
b. Pharmacies and PBMs d. None of the above
c. Pharmacies and LTC facilities
d. Prescribers and PBMs 8. Currently, at the national level, what percent of phar-
e. All of the above macies and prescribers are enabled for e-prescribing in
general?
2. Starting Jan. 1, 2020, pharmacies should not fill paper a. 55 percent of pharmacies and 27 percent of prescribers
prescriptions for controlled substances for Medicare b. 72 percent of pharmacies and 52 percent of prescribers
patients. c. 98 percent of pharmacies and 76 percent of prescribers
a. True d. 100 percent of pharmacies and 95 percent of
b. False prescribers
3. Which federal agency is responsible for determining 9. As of September 2019, what number of states have
which e-prescribing standard is used for the Medicare adopted mandates requiring e-prescribing in general,
Part D program? e-prescribing for controlled substances, or e-prescribing
a. Food and Drug Administration for a subset of controlled substances?
b. Center for Medicare & Medicaid Services a. Eight
c. National Institute of Standards and Technology b. 15
d. Federal Communications Commission c. 22
d. 28
4. The NCPDP SCRIPT standard is only capable of trans-
mitting data that is required by state boards of pharmacy 10. The new version of the NCPDP SCRIPT standard will:
and Drug Enforcement Administration regulations. a. Incorporate new data segments, elements, and codes
a. True to existing messages such as new prescriptions.
b. False b. A dd new messages that allow the exchange of
information not originally contemplated by SCRIPT.
5. It has been approximately ___ years since the industry c. B
oth of the above
has moved to a new version of the NCPDP SCRIPT d. B oth of the above, but (a) will occur one year before
standard for e-prescribing? (b)
a. Two
b. Three 11. Which of the following is true with respect to
c. F
ive NCPDP SCRIPT Version 2017071?
d. Seven a. Compounded prescriptions will finally be properly
transmitted using e-prescribing.
6. The NCPDP SCRIPT standard includes many types of b. T he sig field will be expanded from 140 to 1,000
messages in addition to new prescriptions. characters.
a. True c. A
patient’s primary language will be transmittable.
b. False d. A ll of the above
Continued on page 50
www.ncpanet.org/ap 49
2512. The new version of the NCPDP SCRIPT Standard will 14. The NewRxRequest message is sent by patients to
include the ability to indicate “Do Not Fill” and “Urgent their prescriber when they would rather not schedule a
Rx” in an e-prescription. face-to-face encounter.
a. True a. True
b. False b. False
13. Which of the following is true regarding the new 15. Of the currently available NCPDP SCRIPT standard
NCPDP SCRIPT standard message known as RxTransfer: messages, which is the least utilized:
a. U
nlike the current telephone method of transferring a. New prescriptions
prescriptions, it is a “push” message. b. Refill renewal requests
b. This new message can be used to transfer prescriptions c. Prescription change requests
between pharmacies and from pharmacies to payers d. Prescription cancellations
and pharmaceutical companies.
c. T
he receiving pharmacy must accept an RxTransfer 16. The new RxChange (prescription change request) use
when it is “pushed” to it. case that will likely be of most value to pharmacists is:
d. P harmacists must ascertain whether their state’s rules a. Drug use evaluation
allow the electronic transfer of prescriptions prior to b. Script clarification
using RxTransfer. c. Out of stock
d. Prescriber authorization
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