© 1st American Systems and Services LLC

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NIST NCPDP Analysis –

SCRIPT Fill Status Message for Patient Medication Compliance

August 31, 2011

Prepared by 1st American Systems and Services LLC

for 

National Institute of Standards and Technology

1

st American Systems and Services LLC
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1st American Systems and Services LLC

469 Township Road 1535

Proctorville, OH 45669 

www.1asas.com

Authors

Laura Topor 

ltopormn@msn.com

Frank McKinney

fm@frankmckinney.com
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Contents

A. Introduction.........................................................................................................................................4

B. Background..........................................................................................................................................4

C. Challenges Integrating Fill Status..........................................................................................................5

D. Open Issues .........................................................................................................................................5

E. Barriers to Adoption ............................................................................................................................6
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A. Introduction

The goal of this document is to provide a high-level overview of the NCPDP SCRIPT Fill Status message

(RXFILL), how it fits in to the medication management process, and current industry challenges.

Document sections:

Background. Overview of pharmacy fill status reporting and how the NCPDP SCRIPT Fill Status 

message is designed to support it.

Challenges Integrating Fill Status. Workflow challenges faced by adopters.

Open Issues. Process and other issues related to use of the Fill Status message that the industry has 

yet to resolve.

Barriers to Adoption. Other challenges to adoption of the Fill Status message faces due to other 

industry considerations.

B. Background

Patient medication compliance is a key element in determining clinical outcomes. Compliance data, when 

self-reported, is extremely useful for providers in adjusting treatment plans. However, self-reported data can 

be of questionable integrity. Coupling self-reported data with actual medication fill data from the dispensing 

pharmacy can enhance the quality of the compliance data available to the prescriber.

The purpose of the RXFILL message is to notify a prescriber the dispensing status of a prescription. It can be 

used for both new and refill prescriptions and will indicate if the prescription was filled, partially filled or not 

filled and the reason why. 

The RXFILL transaction is included within the NCPDP SCRIPT Standard. According to the version 10.6 

implementation guide:

The Prescription Fill Status Notification transaction is originated by the pharmacy. The transaction 

notifies the prescriber about the status of a prescription - either new or refill. The transaction can be 

used in three cases - to notify of a dispensed prescription (the patient picked up the medication), to 

notify of a partially dispensed prescription (patient picked up part of the medication), and to notify of 

a prescription never dispensed (patient did not pick up the medication).

Dispensed - in the context of the RXFILL message, means 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’.

Returned to Stock (Not Dispensed) – the procedure of the pharmacy when the patient does not pick 

up a medication that has already been processed and has been waiting for patient pickup when the 

medication is either returned to inventory or destroyed.
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Use of the NCPDP SCRIPT RXFILL is voluntary for pharmacies and prescribers. Implementation and adoption 

will occur over time and there are still issues that the industry needs to resolve to achieve widespread use of 

the transaction.

To-date, the RXFILL message has only been implemented in the long-term and post-acute care settings, as 

part of an integrated medication supply process between a care facility and its institutional pharmacy. Fill 

Status messaging has had no material adoption in ambulatory settings.

C. Challenges Integrating Fill Status 

Since implementation of the Fill Status will occur over time and is not mandated, it is important for end users 

to realize that not all pharmacies and prescribers will be using RXFILL. As such, the data will not be complete 

and that must be considered in any assumptions being made. 

Pharmacies may receive prescriptions in a variety of ways – paper, phone, fax and electronically – and can 

send an RXFILL message for any of these as long as the prescriber is part of the electronic network. If the 

original prescription was not received electronically, the pharmacy will not have an original transaction ID to 

include and therefore must provide enough patient and medication information to allow the prescriber’s 

system to match the message to the correct patient. The industry needs to come to consensus as to when 

RXFILL will be used if the prescription in question was not originally ordered electronically.

End users must note that more than one RXFILL message for a prescription can be sent. A “not dispensed” 

message may be sent today, followed by a “dispensed” message tomorrow. This is clearly driven by the 

timing of the messages and the actions of the patient. Each message should be considered as a snapshot of a 

moment in time. A “not dispensed” message is generally triggered when a pharmacy returns a prescription 

to stock; some pharmacies may hold prescriptions up to 14 days. Yet if the patient shows up the next day, a 

“dispensed” message may be sent. Both the pharmacy and prescriber systems need to be able to support 

these messages and manage them accordingly. For acute medications, other methods may be needed to 

determine if a patient has picked up their medication.

Prescribers, and their systems, must realize that they will receive RXFILL messages only for a portion of the 

prescriptions written by the prescriber. No assumptions should be made about prescription status or patient 

compliance based on the availability of RXFILL messages.

D. Open Issues

Currently, it is not expected that an RXFILL message will be sent when a prescription is transferred from one 

pharmacy to another. As an example, a patient may initially fill the prescription at Pharmacy A and an RXFILL 

message is sent to the prescriber. The patient then goes to Pharmacy B and requests that the prescription be 

transferred and filled there. Related questions being addressed by the industry are:

 Who is responsible for notifying the prescriber that the prescription has been transferred? 

Pharmacy A or Pharmacy B? Is a reason for transfer needed? Is it necessary to identify 

Pharmacy B?

 Pharmacy B would need to know to send an RXFILL message to the prescriber, assuming they 

have this capability.
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 The prescribing system would need a way to link the RXFILL messages from two different 

pharmacies.

Another current consideration is whether it is beneficial for fill information to be returned for every 

prescription and fill, or only in cases where the interest and value is greater. The industry is working to 

modify the NewRX transaction so that the prescriber can indicate if they wish to receive RXFILL messages. 

Doing so will streamline the process by allowing the prescriber to request or opt not to receive an RXFILL 

message at the time they send the new prescription. 

E. Barriers to Adoption

As with any new transaction, there are some general issues that arise within the industry. Limited resources 

are available to program and test new transactions. The benefits of any new transaction must be identified 

and quantified to assist in determining the return on any investments made in implementation. 

When considering RXFILL, there are additional challenges to implementation that can be tied to timing and 

competing priorities for pharmacies and prescribers alike. Pharmacies are currently facing implementations 

of transactions to support HIPAA 2 (namely claims and eligibility). They are awaiting final rules from the 

federal government as to the electronic prescribing of controlled substances and a new version of the SCRIPT 

standard for electronic prescribing. Prescribers are primarily focused on electronic prescribing and 

meaningful use in order to maximize the incentive funds that are available. Prescribers are also facing system 

changes to support HIPAA 2 and the implementation of ICD-10 codes. 

All of these looming requirements, plus any other state or practice initiatives, are likely to take precedence 

over the implementation of transactions such as RXFILL. Pharmacies and prescribers will need to be certified 

to send/receive the RXFILL transaction. This creates yet another step in the implementation process, 

potentially with additional fees, that needs to be completed before use of the RXFILL transaction can occur.

Prescribers will need to determine the value of the RXFILL transaction as compared to the Medication History 

transaction, which can provide some of the same information. Eventually, RXFILL can be sent automatically 

whereas a request for medication history must be sent. They may choose to use RXFILL for patients where 

there are more concerns about compliance so as to get more timely information. RXFILL can be sent for 

prescriptions where the patient paid cash; these are not always included in the medication history 

transaction.