Evaluating the impact of pharmacy-led RxChange interventions on medication use and cost outcomes for electronic prescriptions.

Abstract

Background: The RxChange process provides a streamlined solution within electronic prescribing workflows for a pharmacist-led team to address prescription issues with providers. Its use and effectiveness need to be evaluated to enhance pharmacy-provider communication, improve patient access to care, and increase patient safety.

Objective: To assess the use of the RxChange process on e-prescription content, cost, and changes related to medication safety.

Methods: We conducted a retrospective analysis of national RxChange transactions from 2022 to 2023, using stratified random sampling. All data was obtained from Surescripts. The dataset directly included RxChange response data, shared under agreements to provide limited, time-shifted, and de-identified information. We measured the changes in active ingredients, strengths, dose forms, therapeutic classes, and associated costs before and after the RxChange process. Cost analysis was based on data from the 2021 Medical Expenditure Panel Survey by comparing medication unit costs before and after interventions. Additionally, we analyzed the associations between adverse drug reaction (ADR) codes and the resulting medication modifications.

Results: Our analysis included 1,361,528 RxChange transaction records, focusing on 721,415 prescriber-approved transactions. Medication data mapping using RxNorm API was successful in 93.4% of these records, with 31.3% undergoing significant modifications due to pharmacy interventions. Of these, 43,293 records were linked to cost data, revealing an average unit cost saving of $3.5. Strength changes emerged as the most frequent medication adjustment, particularly in therapeutic interchange scenarios. Out-of-stock situations led to most complex modifications involving simultaneous multiple changes in ingredients, strength, and dose form. ADR-related RxChange requests mostly prompted simultaneous strength and ingredient adjustments in 25.8% of ADR-related transactions.

Conclusions: The study concludes that pharmacy-initiated RxChange communications within the electronic prescription workflow play a crucial role in enhancing e-prescription quality and making pharmacy team interventions more traceable. The findings highlight the importance of pharmacy-provider collaboration in addressing prescribing challenges, facilitating medication adjustments, and supporting efforts to improve medication safety through the RxChange process.