RxFill/RxFillInidicatorChange

rxfill/rxfillindicatorchange overview rxfill is used to provide prescribers with information regarding dispensing activity for a prescription there are three common use cases for rxfill to inform prescribers of a dispensing related activity for adherence monitoring typically used in a retail setting used in ltpac settings to synchronize the care setting or service application with the pharmacy dispensing information the message can be sent by the pharmacy as part of required regulatory notifications that may be sent regardless of the rxfillindicator options sent within a message for prescribing systems, support of the rxfillindicator element includes populating the desired value in prescriber initiated messages such as newrx, rxrenewalresponse, rxchangeresponse, and resupply rxfill messages are not to be sent to a prescriber location that does not have the rxfill service level for pharmacy systems, this includes sending fill status notifications based on the indications selected by the prescriber as well as adding or altering preferred notification types when the rxfillindicatorchange is received per ncpdp guidance, if a rxfillindicator element is sent on the newrx but not on subsequent messages, the preferences selected in the newrx are respected until actively changed by the prescriber rxfill/rxfillindicatorchange workflow and scenarios in the event that prescriber selections are made, the rxfill process starts with sending the rxfillindicator element within the newrx or applicable prescriber initiated message and the pharmacy then tracks the desired indications in subsequent prescriber initiated messages options may be added or altered for the preferred status types if no rxfillindicator is sent on the original newrx, then no rxfill messages should be expected outside of trading partner agreements or regulatory required notifications additionally, prescribers have the ability to send an rxfillindicatorchange message to request alterations to preferred fill status notifications the following scenarios are examples of how the rxfillindicator and rxfillindicatorchange message can be used scenario 1 – prescriber opts into receiving all rxfill notifications and then alters preferred selection prescriber initiated message sent with rxfillindicator signifying “all” to a pharmacy that is enabled for rxfill pharmacy processes the message and tracks the preferred fill status options prescriber chooses to alter selected fill status options to “notdispensed” using the rxfillindicatorchange message pharmacy updates the requested types and sends fill status only when prescription is not dispensed this rxfill message type may be sent when a patient does not pick up an automatic refill and the prescription is returned to stock scenario 2 – prescriber initiates the process to indicate preference for partiallydispensed and notdispensed only , and then chooses not to send any rxfillindicator on an rxrenewalresponse prescriber sends newrx with rxfillindicator signifying “partiallydispensed" and "notdispensed” only pharmacy processes the message and tracks the preferred fill status options pharmacy sends rxfill messages only when the selected dispensing activity occurs this rxfill message type may be sent when a regulatory limitation causes only a partial fill to be dispensed to the patient pharmacy sends rxrenewalrequest prescriber sends an rxrenewalresponse with no rxfillindicator pharmacy system processes the message rxfill messages are sent based on the indication for partially dispensed and not dispensed indications on the newrx note as per surescripts directories requirements, rxfillindicatorchange messages will only be sent to pharmacies that have the service level enabled to allow them to receive rxfillindicatorchange messages rxfill/rxfillindicatorchange requirements r 315 the pharmacy shall support the most recent rxfillindicator for a prescription, either within the message or as an independent rxfillindicatorchange message if the pharmacy does not support rxtransfer, the rxfill fillstatus of transferred is not required to be supported pharmacy systems are required to support all other fill status types pharmacy systems utilizing rxfill are required to support the rxfillindicator element and the rxfillindicatorchange message the prescribing systems utilizing rxfill are required to support the rxfillindicator element and are recommended to support the rxfillindicatorchange message one medication loop must contain writtendate if the medicationprescribed loop is not present, then the medicationdispensed loop must provide writtendate when the status of the message is dispensed or partiallydispensed, then the medicationdispensed segment must be sent when the status of the message is notdispensed or transferred, the medicationprescribed must be sent for any status, both medicationprescribed and medicationdispensed should be sent when available rxfill/rxfillindicatorchange best practices note in the context of an rxfill message, ‘dispensed’ indicates the medication is no longer in the possession of the pharmacy and has been handed, shipped, or delivered to the patient (or the patient’s caregiver/representative) if the medication is still located in the pharmacy, it is not yet ‘dispensed’ the rxfill message contains dispensing and prescription transfer related information and therefore should be linked to any prescribing system initiated message that pertains to the reason the notification is being generated using the relatestomessageid fillable messages and resupply should contain the rxfillindicator if rxfill messages are desired send the facility npi in the facilityidentification element of the rxfill message when known once a prescription transfer is complete the pharmacy that has transferred the prescription should send a final rxfill message to the prescriber indicating the transfer status if the transfer occurred electronically, and rxfillconfirmindicator identifies the new pharmacy as supporting rxfill, then the message should also contain any information available about the pharmacy the prescription was transferred to, in the notes field of the fill status type “transferred” element if the receiving pharmacy does not support rxfill, then the transferring pharmacy should send a rxfill message with a fill status of “transferred” and indicate in the notes field that the receiving pharmacy does not support rxfill while the use of reasoncodes or notes is optional to send in rxfill messages, pharmacy systems are strongly encouraged to support the inclusion of these additional elements the notes field should only be used when adding additional context or information that cannot be clearly communicated using the discrete data elements rxfill/rxfillindicatorchange ltpac best practices when a prescription is sent to a pharmacy via non electronic means (e g , fax), the pharmacy will not have an indication of what types of fill status notifications the prescriber desires in the ltpac care setting, there is still a need to receive an rxfill message for prescriptions sent via a non electronic method partnership agreements can allow rxfill messages to be sent, regardless of the method in which the pharmacy received the prescription resupply messages include the ability to alter selected rxfillindicator preferences if no rxfillindicator element is indicated in the resupply message, no change would be made to previous preferences care should be taken by the prescribing system when sending prescriptions with donotfill on profile only orders this is to indicate to the pharmacy if any dispensing notifications are expected outside of trading partner agreements the rxfill message is one method a prescribing system can use to reconcile a medication received to the original prescription prescribed for the purpose of administration, preventing unnecessary newrxs to the pharmacy