Responding to Pharmacy Rx Change and Script Clarification Requests

Pharmacies sometimes send an Rx Change Request back to the prescriber instead of filling a prescription as written. Common examples include a request to substitute a medication, a prior-authorization question, or a Script Clarification — a free-text question about the prescription, such as confirming the formulation or the directions.

Where Rx Change Requests appear

1. Open the eRx module. Pending requests are shown under Provider Notifications, in the RxChange Requests table.
2. Click Process next to the request to open it. The screen shows the original Prescribed Medication, the pharmacy's note (for example, "Script Clarification: IS IT VAGINAL GEL?"), and the response options: Approve, Approve with Changes, and Deny, plus a Comments field that is sent back to the pharmacy.

If the pharmacy proposed an alternative: select it

When the request includes one or more pharmacy-proposed prescriptions, respond by selecting the one you want — the selection checkbox is at the far right of the requested-medication row (on smaller screens, scroll the table horizontally to reach it). Then click Approve (or Approve with Changes if you're adjusting it), add any comments, and Submit.

If no alternative is present: the two-step process

Script Clarification requests often arrive with only a question and no proposed prescriptions. Because Approve with Changes always transmits a new prescription to the pharmacy, submitting with nothing selected shows the yellow message "You must select a requested prescription to approve with changes." This is a quirk of the e-prescribing workflow, not something you're doing wrong — respond with the steps below.

Step 1: Attach a prescription, then Approve with Changes

1. In the request screen, click Add New Medication and enter the prescription with the clarified detail made explicit (for example, specifying the exact formulation in the directions).
2. Select the prescription you just added, click Approve with Changes, answer the pharmacy's question in the Comments field, and click Submit.

If it submits, you're done — the attached prescription is transmitted to the pharmacy as the approved change, and the request clears from your queue.

Step 2: If the message still appears — deny and re-prescribe

1. Send a fresh prescription first. From the patient's chart, open eRx and write a new prescription for the same medication, making the clarified detail explicit in the directions or pharmacy notes. This gives the pharmacy a clean, unambiguous script with no gap for the patient.
2. Deny the change request to clear it. Back in the request, click Deny, and under Denial Reason choose DeniedOrderExpired. Add a comment for the pharmacy (for example, "New prescription sent with clarified directions"). Click Submit.

Either way, please let our support team know which step worked for you — it helps us keep this guide (and our feedback to the e-prescribing vendor) accurate.

Good to know

• The Denial Reason options use standardized e-prescribing terminology from the pharmacy networks. When you are replacing the script with a new one, DeniedOrderExpired is an option you could use.
• Rx Change Requests cannot be approved for controlled substances. For a controlled substance, skip Step 1: deny the request and send a new prescription (Step 2).
• After you complete a request in eRx, it can take a little while for the count on the home-screen shortcut to update.

If you run into a request you can't complete, contact our support team and include a screenshot — we're happy to help.