Empowering Pharmacists to Be Proactive Care Providers

Benjamin Jolley, pharmacy manager of Jolley’s Compounding Pharmacy, says that for every change request he has for a prescriber, he can either spend an average of 15 minutes sitting on hold or about two minutes sending an electronic RxChange message. “RxChange gives me approximately 13 additional minutes per issue to spend identifying and resolving other drug therapy problems for my patients.”

RxChange lets pharmacies electronically request changes or clarifications to prescriptions, as well as request a prior authorization. This tool conveys these requests directly to prescribers via their electronic health record (EHR) applications, and lets prescribers answer in real time. No phones. No fax machines. Just one-to-one communication and collaboration that lends itself to better patient outcomes.

“I interned with Randy McDonough, of Towncrest Pharmacy, in Iowa City, Iowa, as part of my pharmacy school rotations,” shared Jolley, who graduated from the St. Louis College of Pharmacy. “He taught me to be an interventionist pharmacist, not just a ‘checker.’ This means that rather than just try to push prescriptions out the door as fast as possible without changes because the product in the bottle matches the prescription, I try to ensure that the goals of therapy are met with by the prescribed therapy.”

“Having a more elegant method of communicating these outputs to our physician partners means that I can spend more time intervening and less time waiting to intervene,” Jolley added.

Furthermore, the messaging functionality helps prescribers, too. “With a good EHR workflow on the physician’s side for these types of messages, they spend much less time addressing my recommendation than they otherwise would—just a read of my note and an ‘approved’ or ‘denied’ should close the loop of communication, rather than them having to take a paper note from an assistant, pull up the patient chart, re-enter the prescription per my request and then discontinue the obsolete prescription.”

RxChange can also improve patient care by eliminating wait times and allowing for more cost-effective therapies, which increase medication adherence and ensure patients are taking needed medications. According to a recent survey, over half of patients reported that they had not taken a medication because it was too expensive, and three in 10 had not taken a prescription because it took too long to fill.

Jolley said, “I’ve spent so much time waiting on hold to tell a medical assistant that I want prescription X changed to Y, or to clarify a prescription. The fact that I no longer have to wait to talk to someone, but rather have the ability to send a structured message directly to the physician's EHR workflow, with exactly what I want sent over, is invaluable.”  

The value is starting to speak for itself. Last year, Surescripts processed 11.7 million RxChange transactions, per our National Progress Report, up from just 84,000 in 2018. As of May, 53% of retail pharmacies were enabled for RxChange and 28% are actively sending transactions, up from 6% and less than 1 percent in 2018, respectively.

Much of RxChange’s growth in 2019 was driven by three unique use cases:

• A 1,594% increase in RxChange for Prior Authorization messages sent by pharmacies
• RxChange for Therapeutic Interchange messages increased 168 times in volume
• A nearly 450% increase with RxChange for Generic Substitution messages

These three form part of the seven unique use cases for RxChange included in the National Council for Prescription Drug Programs (NCPDP) SCRIPT Standard Version 2017071.

CVS Health’s Senior Advisor of Pharmacy Operations Tyler Bogardus, said his team primarily uses RxChange for Therapeutic Interchange and Script Clarification. Common use cases include requesting an alternative due to an insurance rejection or requesting a change in the days’ supply, if needed. 

The transaction is showing further utility in the midst of the coronavirus. The U.S. Food and Drug Administration has taken action to manage potential drug shortages due to the pandemic, and RxChange can help. Pharmacies can send RxChange requests to prescribers to let them know a medication is out of stock, and prescribers can respond and initiate any changes for the pharmacy.

Bogardus, a graduate of Albany College of Pharmacy and Health Sciences, said that while many prescribers aren’t working in their normal office locations during the pandemic, they can respond to RxChange requests if they can access their electronic health record (EHR) system remotely. “This [responsiveness] would not be the case if we needed to communicate via fax or phone,” he said. “We have seen a reduction in the amount of time it takes for a request to be resolved with RxChange compared to fax. This is critical to avoid any delays in patient therapy.”

“While the workflow for our pharmacy teams is identical as far as how the requests are initiated, the ability to communicate electronically has improved the speed and efficiency of managing the requests and requires less manual intervention,” explained Bogardus.

If you’d like to learn more about the progress being made with RxChange, be sure to check out our 2019 National Progress Report.