--- description: Manage pharmacy-initiated prescription renewal requests using RxRenewalRequest NCPDP SCRIPT message. --- # RxRenewal Message ## Overview RxRenewal is a type of message sent by pharmacy to subscriber when the medication should be renewed. It is required that RxRenewal is preceded by NewRx. ## Responding to RxRenewalRequest ### Decisions use cases {% hint style="info" %} **MedicationRequest.extension.where(url = "http://aidbox.app/ePrescription/FHIRSchema/medication-request-pharmacy-request-refills")** referred as **PharmacyRequestedRefills** for simplicity {% endhint %} *Example 1:* Prescriber wishes to deny the request because the patient must be re-examined. Response must be `denied` *Example 2:* Pharmacy has not requested a specific number of refills (**PharmacyRequestedRefills** not sent); prescriber wishes to approve the request, specifying 3 additional dispensings. Since the pharmacy did not request a specific number of refills **PharmacyRequestedRefills** and the **MedicationRequest.dispenseRequest.numberOfRepeatsAllowed** contains a value greater than zero, the response must be `approved`. *Example 3:* Pharmacy requests 5 refills **PharmacyRequestedRefills**; prescriber approves 3 refills **MedicationRequest.dispenseRequest.numberOfRepeatsAllowed** Since this is a change in **MedicationRequest.dispenseRequest.numberOfRepeatsAllowed** versus **PharmacyRequestedRefills**, the response must be `approved-with-changes`. *Example 4:* Prescriber changes **MedicationRequest.dosageInstruction.\*.text** from “Take one tablet daily” to “Take one tablet morning and evening.” (**MedicationRequest.dispenseRequest.quantity** and other fields may change as well). Response must be `replace`. *Example 5:* Pharmacy has not requested a specific number of refills (**PharmacyRequestedRefills** not sent); prescriber wishes to approve the request, specifying 3 additional dispensings. In addition, the prescriber changes **MedicationRequest.dosageInstruction.\*.text** from “Take one tablet daily” to “Take one tablet morning and evening.” ( and other fields may change as well). Response must be `replace`. *Example 6:* If the prescriber wishes to send a new prescription to a different pharmacy (other than the one who made the RxRenewalRequest), the `replace` is an inappropriate response. A `denied` should be sent to the pharmacy that made the RxRenewalRequest, and a new prescription should be sent to the new pharmacy. *Example 7:* The pharmacy sent an RxRenewal request proposing to renew Lipitor 20 mg. The prescriber responded with an RxRenewalResponse of type `pending`, indicating that a decision could not yet be made and that further review was required. The prescriber must wait for subsequent RxRenewalRequest messages from the pharmacy, as once a request has been answered with `pending`, it cannot later be responded to again with `approved` or `denied` for the same transaction. ### Denied Same as for [RxChange](rx-change.md#denied). `denied` is the decision that requires the least amount of steps. Setting it in the extension is the only requirement. You can set the denial reason (free text) in decision note extension ( `http://aidbox.app/ePrescription/FHIRSchema/medication-request-rx-renewal-decision-note`), but this is optional. ### Pending Same as for [RxChange](rx-change.md#pending). Before committing the `pending` decision you need to Set the decision itself: ```yaml extension: - url: >- http://aidbox.app/ePrescription/FHIRSchema/medication-request-rx-renewal-decision valueCode: pending ``` Set the expected pended response date: ```yaml extension: - url: >- http://aidbox.app/ePrescription/FHIRSchema/medication-request-rx-renewal-expected-pended-response-date valueDate: '2025-12-12' ``` Set the decision note (contrarily to `denied` decision, it's required for `pending`): ```yaml extension: - url: >- http://aidbox.app/ePrescription/FHIRSchema/medication-request-rx-renewal-decision-note valueString: Provider is on vacation ``` Set the reason code: ```yaml extension: - url: >- http://aidbox.app/ePrescription/FHIRSchema/medication-request-rx-change-decision-reason-code valueCodeableConcept: coding: - code: HR system: urn:app:aidbox:e-prescriptions:surescripts:decision-reason-code display: Provider is unavailable and no one is available to make a decision ``` Available reason codes are listed in the table below (same for RxChange case): | reason code | meaning | |-------------|---------------------------------------------------------------------------------| | **HP** | Patient has an appointment scheduled | | **HQ** | Patient has labs/tests pending | | **HR** | Provider is unavailable and no one is available to make a decision | | **HS** | Patient is currently undergoing acute care and a decision is pending resolution | | **HT** | Provider wishes to delay for reasons not otherwise indicated | ### Approved, ApprovedWithChanges These decisions are used when prescriber approves the renewal requests.
Decisions differ by the approved number of refills The difference between `approved` and `approved-with-changes` is about the allowed number of refills. The number of refills requested by the pharmacy is stored in the following extension: ```yaml extension: - url: >- http://aidbox.app/ePrescription/FHIRSchema/medication-request-pharmacy-request-refills valueInteger: 1 ``` The number of refills approved by the prescriber is taken from `MedicationRequest.dispenseRequest.numberOfRepeatsAllowed`. Usage of `approved` decision expects these values to be equal. Usage of `approved-with-changes` decision expects these values to differ.
While the e-prescriptions module could prefill fields like `MedicationRequest.dispenseRequest` and `dosageInstruction`, the general approach is to let the prescriber do that. Set the decision: ```yaml extension: - url: >- http://aidbox.app/ePrescription/FHIRSchema/medication-request-rx-renewal-decision valueCode: approved # valueCode: approved-with-changes ``` If during the process of handling incoming renewal request there was a `DetectedIssue` created (meaning there were mismatches between incoming and existing data), make sure you have resolved the references to implicated contained resources: - `Patient` - `MedicationRequest.subject` - `PractitionerRole` - `MedicationRequest.performer` - `Practitioner` - `PractitionerRole.practitioner` - `Location` - `PractitionerRole.location` or `PractitionerRole.organization` - `Pharmacy` - `MedicationRequest.requester` - `Medication` - for medications contained resource is supported, so it's up to you whether to resolve it or leave as is - `MedicationRequest.medication` Set `MedicationRequest.dispenseRequest` and `MedicationRequest.dosageInstruction`. Typically, they are the same as in the request for NewRx: Make sure you set - `MedicationRequest.dispenseRequest.performer` (the pharmacy of initial renewal request) - `MedicationRequest.dispenseRequest.numberOfRepeatsAllowed` ```yaml dispenseRequest: quantity: code: C48542 unit: Tablet value: 60 system: urn:app:aidbox:e-prescriptions:ncpdp:QuantityUnitOfMeasure performer: reference: Organization/my-pharmacy expectedSupplyDuration: code: d unit: days value: 30 system: http://unitsofmeasure.org numberOfRepeatsAllowed: 1 dosageInstruction: - text: TAKE ONE TABLET TWO TIMES A DAY UNTIL GONE ``` ### Replace The `replace` response is to be used when an approval includes changes outside of what is permissible for `approved` and `approved-with-changes` responses. It should only be used if data elements have been changed from the RenewalRequest and when an `approved` or `approved-with-change` response is not appropriate. Note: - Minor corrections to the patient **birthdate** are allowed as long as it refers to the same patient. On a `replace` response the data content for the patient information does not have to match exactly as long as it is referring to the same patient. For example, if the **patient.name.\*.given.\*** in the RxRenewalRequest is Bob and the patient **patient.name.\*.given.\*** in the RxRenewalResponse is Robert, there is no difference unless the prescriber believes they are referencing a different patient than the pharmacy or vice versa. - Edits to the pharmacy are not permitted. - **authoredOn** indicates the date of the replacements prescription. Before committing the `replace` decision you need to Set the decision itself: ```yaml extension: - url: >- http://aidbox.app/ePrescription/FHIRSchema/medication-request-rx-renewal-decision valueCode: replace ``` Set the decision note (it's not required for `replace` decision but recommended): ```yaml extension: - url: >- http://aidbox.app/ePrescription/FHIRSchema/medication-request-rx-renewal-decision-note valueString: Changed course of therapy, so different medication is required ```