Prescriptions Guide - Frequently Asked Questions

Documenting medications

In Elation, what is the difference between “documenting a medication” and prescribing a medication?	‘Documenting a medication’ is when you record a medication that a patient is (or was) taking. In a case like this, you may not be the provider that ordered the medication. Prescribing a medication is when you order medication for the patient.
How do I document a medication a patient is actively taking?	You can use the Document Medication form to document a medication that a patient is taking. Use one of the following methods to access the Document Medication form: Click the + Document Med Pt is On button in the Permanent Rx Meds or Permanent OTC Meds section of the Clinical Profile • Click Rx -> Document Med Pt is On at the top of the patient’s chart Click here to learn more about the Document Medication form.
How do I document a medication that a patient is no longer taking?	You can use the Document Discontinued Med form to document a medication that a patient has discontinued taking. To access this form, click Rx -> Document Discontinued Med at the top of the patient’s chart. Click here to learn more about the Document Discontinued Med form.
How do I edit a medication that is currently listed in the patient’s Medication List? (ex. change the dose)	To edit a medication that is listed in the patient’s medication list, click Actions -> Document Change next to the name of the medication. Click one of the Save buttons after noting the changes to save the changes to the patient’s medication list.
How do I document multiple medications at once?	The Document Medication form has the option for you to document multiple medications, one after another, by clicking the Save & Add Another button after documenting a medication. Click here to learn more about the Document Medication form
How do I discontinue a medication that is currently listed in the patient’s Medication List?	To discontinue medication that is in the patient’s medication list, click Actions -> Document Discontinue if the order to discontinue was made by another provider or click Actions -> Rx: Discontinue if you are the provider that is discontinuing the medication.
Why did documenting a medication also discontinue an earlier order of the same medication?	If the documented medication matches an existing active medication (same name and dosage), Elation adds the new record to that medication thread. Discontinuing the medication — including during medication reconciliation — discontinues the medication thread, which includes all medications in that thread.
How do I eliminate duplicate medications from the patient’s Medication List?	To merge duplicate medications Click Actions -> Merge with Other Med. • Select the medication(s) you want to merge with. • Click Merge with Selected Med(s). While duplicate medications can also be deleted, we recommend using the Remove Medication sparingly as deleted records cannot be retrieved. Only delete if it is a true duplicate.
Do I need to enter Sig, Qty and Units when documenting existing medications?	While the Sig, Qty and Units fields are not required when documenting medications, we highly recommend including this information when documenting existing medications as this information will expedite the medication refill process.
Where can I find the Qty and Units fields when documenting existing medications?	Click the more… button at the bottom of the Document Medication form to see additional fields for Qty, Units, Rf and Indic’n.

Prescribing/ordering medications (general)

How do I refill a medication that’s listed in the patient’s Medication List? To refill an existing medication in the patient’s chart Click here to learn more about the Prescription Form.

Find the medication in the Clinical Profile or Medication History (under the Meds Hx button at the top of the patient’s chart).
Click Actions -> Rx: Refill.
Complete the Prescription Form.

How do I refill a medication that’s not listed in the patient’s Medication List? You can use the Prescription Form to refill medications, even when the medication is not in the patient’s chart yet. Click here to learn more about the Prescription Form.

Use one of the following methods to access the Prescription Form:

Click Rx -> Prescription Form (Rx/OTC/CS) at the top of any patient’s chart.
Click the Rx/OTC/CS button in a visit note or non-visit note draft.

Click on the Type dropdown at the top of the Prescription Form and select Refill.
Complete the Prescription Form.

How do I refill multiple medications at once? To refill multiple medications from the medication list at once, click the **+ Bulk Refill ** button in the Permanent Rx Meds or Permanent OTC Meds section of the Clinical Profile. All of the medications in the corresponding lists, along with the details from the last documentation/order, will populate in the Prescription Form for you to continue your prescription order(s). How do I queue multiple medications in a single prescription?

The pharmacy selected for the first medication in the form will become the default pharmacy for subsequent medications that are eligible to be ePrescribed. Optionally change the selection to a different pharmacy if needed.

To queue multiple prescriptions in a single order, click the + Add Another Rx button towards the bottom left of the Prescription Form. You can queue various medication types in a single order; including over-the-counter and both non-controlled and controlled substance medications. If I queue multiple medications and then click Save as Draft & Close, will the medications remain in one queue in the same prescription form when I open the draft? All queued medications will come back into the same queue in the prescription form. For example, if you queue 3 medications and then click Save as Draft & Close, opening any medication draft will open all 3 medications in a single queue again. Which fields are required for prescription orders? The following fields are required for prescription orders: If the prescription needs to be sent electronically to a pharmacy then the Pharmacy field must also be filled out. Click here to learn more about the different fields in the Prescription Form.

Medication name and strength
Sig
Qty
Refills

I cannot find the medication I want to prescribe in Elation’s medication database. Can I add this medication to the database?

Medications that are manually added to the medication database will not be associated with a National Drug Code (NDC). This means Elation will not be able to provide any details around allergy interactions, drug interactions or intolerances, formulary information, or prescription cost estimatesYou will not be able to ePrescribe compound controlled substance medications.

If you are unable to find the medication you wish to prescribe, you can manually add it to your database by following these steps:

Type the medication name in the Medication name and strength field.
If the correct medication appears in the search list, select it.
If the list does not include the medication you need, click anywhere outside the list to close it.
Click Add a new med under the name.
Edit the Name, Strength, and Medication Type as needed.
Click Create Medication & Continue Rx.

How do I prescribe a compound medication?

Elation’s medication database has some of the commonly prescribed compound medications. However, you may need to manually add a compound non-controlled substance medication to your database in order to prescribe it. You can manually add it to your database by following these steps:

Type the medication name in the Medication name and strength field.
If the correct medication appears in the search list, select it.
If the list does not include the medication you need, click anywhere outside the list to close it.
Click Add a new med under the name.
Edit the Name, Strength, and Medication Type as needed.
Click Create Medication & Continue Rx.

Can I delete a custom or compound medication I no longer use from my medication database? Not currently — there isn’t a self-service option in the Elation UI to remove a user-created medication from your practice’s medication database. Are electronic prescriptions, including compound medications, uploaded to a shared pharmacy database that other pharmacies or offices can see? No. Each electronic prescription — including non-controlled compound medications sent electronically — is transmitted through our e-prescribing partner, Surescripts, only to the specific pharmacy you select in the Prescription Form. Elation does not upload prescriptions to a shared database that other pharmacies or offices can browse. Separately, pharmacies may be required to report controlled substance dispenses to your state’s Prescription Monitoring Program (PMP/PDMP). This is a state-managed database, not an Elation-managed shared pharmacy database. Click here to learn more about PMP/PDMP integrations. How do I prescribe to TrumpRx or another discount card/coupon program? TrumpRx, like GoodRx, is not a pharmacy — it’s a coupon program that offers discounted cash pricing at the patient’s regular pharmacy. Continue to select the patient’s preferred pharmacy in the Prescription Form as you normally would; the patient can then present their TrumpRx or other coupon at that pharmacy to pay with the discounted price instead of using their insurance. I am unable to find the unit I want to use to order a medication. What should I do? In an effort to provide more accurate and precise quantity and dosing information to pharmacies to dispense medications to patients, the National Council for Prescription Drug Monitoring Programs (NCPDP) has specified which quantity units are acceptable for prescribing. Below is a list of all the accepted prescription units and their recommended alternatives. When each is one of the recommended alternatives for a deprecated unit but other recommended alternatives are available, the NCPDP suggests that you choose one of the other more appropriate terms (e.g. choose ‘mL’ for ampule instead of ‘each’). Deprecated Unit Recommended Alternative Ampul mL or each Applicator grams or mL Bag grams or mL Bar each Bead grams Block each Bolus mL Bottle mL Can grams, mL, or each Canister grams or mL Carton grams, mL, or each Cartridge mL Case grams, mL, or each Cassette grams, mL, or each Container grams, mL, or each Cylinder grams, mL, or each Device each Disk each Dose pack grams, mL, or each Dual pack grams, mL, or each Fluid ounce mL French each Gallon mL Inhalation grams, mL, or each Inhaler grams, inhaler, mL, or each Inhaler refill grams, mL, or each Internation unit iu Intravenous bag mL Kilogram grams Liter mL Microgram microgram Milliequivalent grams or mL Milligram grams, milligram Nebule mL, nebule Needle free injection mL Ocular system each Ounce grams Package grams, mL, or each Paper each Pint mL Pouch grams, mL, or each Pound grams Pre-filled pen syringe mL, pre-filled pen syringe Puff grams or mL Pump grams or mL Quart mL Sachet each Scoopful grams, mL, or each Spray grams or mL Syringe mL, syringe or each Tablespoon mL Tabminder each Tampon each Teaspoon mL Tray grams, mL, or each Tube grams, mL, or each Vial mL, vial or each Deprecated Unit Recommended Alternative Ampul mL or each Applicator grams or mL Bag grams or mL Bar each Bead grams Block each Bolus mL Bottle mL Can grams, mL, or each Canister grams or mL Carton grams, mL, or each Cartridge mL Case grams, mL, or each Cassette grams, mL, or each Container grams, mL, or each Cylinder grams, mL, or each Device each Disk each Dose pack grams, mL, or each Dual pack grams, mL, or each Fluid ounce mL French each Gallon mL Inhalation grams, mL, or each Inhaler grams, inhaler, mL, or each Inhaler refill grams, mL, or each Internation unit iu Intravenous bag mL Kilogram grams Liter mL Microgram microgram Milliequivalent grams or mL Milligram grams, milligram Nebule mL, nebule Needle free injection mL Ocular system each Ounce grams Package grams, mL, or each Paper each Pint mL Pouch grams, mL, or each Pound grams Pre-filled pen syringe mL, pre-filled pen syringe Puff grams or mL Pump grams or mL Quart mL Sachet each Scoopful grams, mL, or each Spray grams or mL Syringe mL, syringe or each Tablespoon mL Tabminder each Tampon each Teaspoon mL Tray grams, mL, or each Tube grams, mL, or each Vial mL, vial or each Do I still need to fill out the Sig or Qty fields if I filled out the Days Supply field? The Days Supply field does not replace the Sig or Qty fields. The Sig and Qty fields will always be required for any prescription order. Will the Days Supply field populate automatically based on the Sig and Qty I entered? The Days Supply field does not populate automatically. You must manually enter a number in the Days Supply field if required for the medication you are ordering or if you want to see prescription cost estimate information. Where does the NDC & packing information come from? The Packaging (NDC) information that is selected by default is the default NDC & packaging information that is provided by our medication database provider. Can I select my own default NDC & packaging for a medication I commonly order? Yes, you can use the Rx Templates feature to save any Medication along with its Sig, Qty, Units, Refills, Days Supply, & Packaging (NDC) information as a template to use for any prescription for any patient. Click here to learn more about the Rx Templates feature. Are diagnosis codes required for prescriptions? While Diagnosis (ICD-10) is not a required field on the Prescription Form, certain insurances may require diagnosis codes for coverage purposes or prior authorizations. You can associate as many diagnosis codes as you want to with a prescription but only the first 2 diagnosis codes will be sent to the pharmacy. How many diagnosis codes can I send per prescription? You can associate as many diagnosis codes as you want with a prescription but only the first 2 diagnosis codes will be sent to the pharmacy. Can I store default pharmacies for specific medications? You cannot store default pharmacies for specific medications. You can only store preferred pharmacies at the patient level. How do I print a prescription instead of sending it to a pharmacy? Click the Manual printout only option in the pharmacy search to print a prescription instead of sending it to a pharmacy. How do I fax a prescription to a pharmacy? To fax a prescription to the pharmacy

Print the prescription and use the Print to PDF or Save as PDF function in the print window to save a PDF copy of the prescription to your computer.
Upload the PDF back to the patient’s chart
Attach it to a Letter to Provider to fax it to the pharmacy.

I often enter the same details for certain medications that I order. Can I save this information as a template for all my prescriptions? Yes, you can use the Rx Templates feature to save any Medication along with its Sig, Qty, Units, Refills, Days Supply, & Packaging (NDC) information as a template to use for any prescription for any patient. Click here to learn more about the Rx Templates feature. I am trying to send a prescription to the pharmacy for a patient but the patient does not have an address. What should I do? Patient addresses are required for both non-controlled and controlled substances.

If the patient is homeless, store the word HOMELESS in the Address field and enter the City, State, and Zip for your local area.
f you are unable to obtain an address for the patient, store the word UNKNOWN in the Address field and enter the City, State, and Zip for your local area.

I am a Workspaces user. What do I need to know about the Prescription Form? As a Workspaces user, you will only see the Practice Locations specific to your Workspace when sending prescriptions to the pharmacy. The first Practice Location listed in the Workspace will always be the default location. Workspace users will not be able to select a default prescribing location for ePrescribing. Will I be notified when a patient picks up a prescription at the pharmacy? Pharmacies have the option to send fill statuses to Elation. If they do, the information will appear at the bottom of the prescription record within the patient’s chart. Click here to learn more about fill status notifications. I received a message from the pharmacy about a change request. What should I do? You may see change requests in your Rx Requests Practice Home queue if the pharmacy requests changes to a prescription that you sent. Pharmacies most commonly send prescription change requests if the patient requests a generic substitution at the pharmacy, for script clarification, or in the event that the medication is out of stock. Review the change request and then take the appropriate action to respond to the request. Click here to learn more about prescription change requests. Can I reassign an item in the Rx Requests queue to a different provider? Yes — you can reassign an eRx renewal (refill) request to a different eligible provider. Open the request in Requiring Action, then choose Reassign to Provider. The renewal is then responded to under the newly assigned provider, and the feed shows Reassigned from Dr. A → Dr. B. Eligible reassignment targets are Provider Level Users with an ePrescribing account and an active Surescripts enrollment. For controlled substance renewals, the target must also be EPCS-capable. The assigned provider or their Authorized Rx Delegates can reassign a renewal request.

Exception: Prescription change requests in the Rx Requests queue cannot be reassigned. Change requests stay addressed to the provider the pharmacy sent them to.

For step-by-step instructions, see Reassigning an eRx renewal request. How do I cancel a prescription I sent to the pharmacy?

Pharmacies should respond to cancellation requests within 12 hours, but pharmacies are not obligated to keep to this timeframe. If you do not receive a response from the pharmacy to the cancellation request within 24 hours, we recommend directly contacting the pharmacy.If you would like to reverse an in-progress cancellation request, you must contact the pharmacy directly to suspend the request.Deleting a prescription from the chart will not notify the pharmacy to cancel it. Follow the steps above to notify pharmacies of cancellation requests.

To cancel a prescription that was sent to the pharmacy: You will see a message at the bottom of the chart that says ‘This eRx order to…was canceled….” once the pharmacy processes your cancellation request. Click here to learn more about prescription cancellation requests.

Locate the prescription in the patient’s chart.
Click Actions -> Cancel this eRx order.

Can I edit a prescription after it’s been sent to the pharmacy? No, a prescription can’t be edited once it’s been sent to the pharmacy. If it needs to be corrected — for example, the wrong dose or units — cancel or discontinue the existing order and create a new prescription with the correct details. Click here to learn more about canceling a prescription sent to a pharmacy. Can staff prescribe on a provider’s behalf?

An ‘Authorized Rx Delegate’ is not allowed to ePrescribe controlled substance medications or address controlled substance medication script requests on a provider’s behalf due to DEA regulations.

Provider Level Users can assign Staff Level Users as prescription delegates which authorizes them to execute non-controlled substance prescription orders on a prescriber’s behalf in the EHR. These non-controlled substance prescription orders include:

Transcribe prescription orders in the EMR and send new non-controlled substance prescriptions electronically to the pharmacy on a provider’s behalf.
Transcribe verbal approval or denial of a non-controlled substance prescription refill or change request received from a pharmacy and send that approval or denial electronically to the pharmacy on provider’s behalf.
Transcribe provider’s order to discontinue a non-controlled substance medication in the EHR for documentation purposes.
Transcribe provider’s order to cancel a non-controlled substance medication sent to a pharmacy.

Prescribing/ordering medications (specific to controlled substance medications & EPCS) Can I ePrescribe controlled substance medications? Yes, you can ePrescribe controlled substance medications after you complete a special registration process.

Begin by going to the Settings page in Elation and see if you see the ePrescribing Controlled Substances (EPCS) settings page. If you do, proceed to Step 2.

If you do not see the ePrescribing Controlled Substances (EPCS) settings page, click I need help ->Contact Elation Support to request access. A member of the Elation Team will assist you with turning this feature on and if applicable, assist you with understanding any associated costs for using this feature.

Complete the EPCS signup process.

How do I ePrescribe controlled substance medications? To ePrescribe controlled substance medications after completing the EPCS signup process: Click here to learn more about EPCS.

Click the Rx -> Prescription Form (Rx/OTC/CS).
Complete all necessary fields, especially Pharmacy.
Click Prescribe.
Review the details of your prescription and click Prescribe again.
Enter your EPCS Password and Security Code to complete your order.

How do I queue multiple controlled substance medications in a single prescription?

To queue multiple controlled substance prescriptions in a single order, click the + Add Another Rx button towards the bottom left of the Prescription Form. You can queue various medication types in a single order; including over-the-counter and both non-controlled and controlled substance medications. If I ePrescribe multiple controlled substance medications in a single order, do I need to enter my EPCS Password and Security Code multiple times? If you are ePrescribing multiple controlled substance medications in a single order, you only need to enter your EPCS Password and Security Code one time. Can my staff prescribe controlled substance medications on my behalf? Staff cannot prescribe controlled substance medications, even if they are an Authorized Prescription Delegate. Authorized Prescription Delegates can only prescribe over-the-counter and non-controlled substance medications. How many diagnosis codes can I send per controlled substance prescription? You can associate as many diagnosis codes as you want to a prescription but only the first 2 diagnosis codes will be sent to the pharmacy. Why can’t I ePrescribe custom or compound medications that contain controlled substances? The database of controlled substance medications that are available to e-prescribe through Elation are from the national Medispan medication database. You can add custom or compound medications to this database but you cannot ePrescribe custom or compound controlled substance medications because we currently do not have the option to allow you to associate a custom NDC code to medications you create. To prescribe custom or compound controlled substance medications, print the controlled prescription on tamper proof paper and hand it to the patient. Why is my controlled substance prescription failing to be sent to the pharmacy? If you, the Provider, have completed the EPCS signup process and the Token Password and Security Code you enter when e-Prescribing is accurate, there are a few other factors that may prevent a Controlled Substance prescription from being sent electronically in Elation.

Be sure Patient Demographics are filled with no special characters or abbreviations in the following fields:

Name:
- Entering a patient’s middle name is applicable, but DO NOT include a ‘nickname’ or goes by in the Middle name field. This information should be added to the Full name field. instead.
Address:
- Spell out abbreviations
  - Ave- Avenue, ST- Street, etc.
  - PO Box addresses will not be accepted, it is strongly recommended to enter physical addresses.
City & Zip Code

Be sure that all of your credentialing information has been uploaded to Elation:

It is important to note that Schedule I & II drugs will not allow for:

Post-dated prescriptions
Refill quantity amounts in the order form. The Refill field must say 0.

Why can’t I delete a controlled substance prescription from the Chronological Record? The DEA requires that any prescriptions for controlled substances remain documented within the patient’s health record. This means controlled substance prescriptions can never be deleted from the EHR once the prescription order is signed. What does the VIP Push button do? The VIP Push button sends a pop up notification to your smartphone and provides you the option to approve or deny the EPCS request rather than opening the app to enter a security code.

EPCS Registration & Account Management

Click here for a detailed FAQ about EPCS. For complete information about electronic prescribing of controlled substances, see the following articles:

EPCS (Electronic Prescribing of Controlled Substances) Introduction– Learn about EPCS requirements and how to get started.
EPCS Guide - Signing up for EPCS – Step-by-step instructions for completing EPCS registration.
EPCS Guide - Managing EPCS Access Controls – How to manage Access Control permissions for EPCS.
EPCS Guide - Updating your EPCS Token or password – How to register a new token, reset your password, and troubleshoot token issues.
EPCS Guide - ePrescribing controlled substance medications & troubleshooting – End-to-end prescribing workflow and common issue resolution.

Prescription Templates (Rx Templates) and Custom Rx Sigs

I often enter the same details for certain medications that I order. Can I save this information as a template for all my prescriptions?	Yes, you can use the Rx Templates feature to save any Medication along with its Sig, Qty, Units, Refills, Days Supply, & Packaging (NDC) information as a template to use for any prescription for any patient. Click here to learn more about the Prescription Templates feature.
How do I apply a Rx Template to a prescription order?	To apply a Rx Template to a prescription order: Open the Prescription Form. • Search for the medication that the template is for. • Select the Prescription Template from the search results
What is a custom Rx sig?	Elation associates specific sigs with specific medications to expedite the prescribing workflow. If you do not see the sig you want to assign to a prescription, you can enter a customer sig and add it to your Sig database to use with other prescription orders.
How do I add a custom Rx sig to my Sig database?	To add a custom Rx sig to your Sig database, follow these instructions: Open the Prescription Form
How do I edit a custom Rx sig in my Sig database?	To edit a custom Rx sig in your Sig database: Click Settings. • Click Prescriptions under Practice Settings. • Go to the Custom Rx Sigs section & click Edit next to the custom rx sig you want to edit. • Edit the sig as needed. • Click Save.
How do I delete a custom Rx sig from my Sig database?	To delete a custom Rx sig from your Sig database, follow these instructions: Click Settings. • Click Prescriptions under Practice Settings. • Go to the Custom Rx Sigs section & click Delete next to the custom rx sig you want to delete.
How do I apply a custom Rx sig to a prescription order?	To apply a custom Rx sig to a prescription order: Open the Prescription Form. • Select the medication you want to order. • Click in the Sig field. You will automatically see all available sigs for the medication. Custom rx sigs will be at the top of the list and will have a User label to the right of the search results. • Select the custom rx sig you want to use.
Who has access to my Rx Templates and custom Rx sigs?	All users in the practice have access to your Rx Templates and custom Rx sigs.
Can I save “Instructions to Pharmacy” text as part of an Rx Template?	No, Rx Templates only save the Medication, Sig, Qty, Units, Refills, Days Supply, and Packaging (NDC) fields. The Instructions to Pharmacy field is not template-able. If the text belongs in the patient-facing directions instead, save it as a Custom Rx Sig. Otherwise, consider using a text-expander or keyboard shortcut to enter it consistently.
Why doesn’t selecting an Rx Template for a controlled substance prompt me for my EPCS Token Password and Security Code?	In the medication search results, controlled substance medications display a C indicator next to the medication name. Rx Templates saved for a controlled substance don’t carry that indicator, so selecting the Rx Template version won’t trigger the EPCS signing prompt. Select the controlled substance entry marked with the C indicator instead. Click here to learn more about ePrescribing controlled substances.

Drug decision support

Click here for the full drug decision support feature guide.

What is drug decision support?	Drug decision support is a feature that allows you to see drug-to-drug interactions or drug-to-allergy interactions while you are drafting prescription orders. For optimal use of this feature, you must keep an up to date list of patient’s allergies, drug intolerances and medications in their chart. You must select allergies, drug intolerances and medications from Elation’s database in order for drug decision support to work.
Where does the drug decision support information come from?	The drug decision information is based on the following: Allergies, drug intolerances and medications documented in the patient’s chart • Clinical data from our drug database provider, MediSpan, a Wolters Kluwer© company.
What are the different types of interaction alerts?	Drug decisions support alerts are categorized into the following: Minor interactions • Moderate interactions • Major interactions
What should I do when I see an interaction alert?	Best practice is to click on the alert to read the full details of the alert. If you choose to proceed to prescribe a medication with a major interaction alert, you will be required to enter a reason for overriding contra-indication.
How do I check my drug decision support settings?	Drug decision support Settings are provider specific. This means only Provider Level Users can adjust their drug decision support settings in their own Elation EHR account. Go to Settings -> Preferences -> Drug Decision Support. • Adjust your Drug-to-Drug alerts as needed. You have the following options • Turn on or off your Drug-to-Allergy alerts as needed. • Changes will be saved automatically on this page. Click here to learn more about the drug decision support feature.

Prescription insurance benefits

Click here for the full prescription insurance benefits guide. Where can I see prescription insurance benefits for my patient? The prescription insurance benefits information is displayed at the right hand side of the Prescription Form. What prescription insurance benefits information can I see in Elation? Elation will show the following prescription insurance benefits information as provided by the patient’s Pharmacy Benefits Manager:

The coverage information tells you whether a patient has prescription benefits coverage and which Pharmacy Benefits Manager (PBM) covers the patient. Elation will show all prescription coverages available for the patient.
The formulary information serves as a guide for both healthcare providers and patients, outlining which medications are approved for coverage and the corresponding coverage limits and statuses. The formulary status tells you whether a medication is potentially reimbursable by the patient’s insurance and whether the medication is preferred and/or on- or off-formulary. Preferred medications are generally cheaper than non-preferred medications. Non-formulary medications may require prior authorization or have additional cost considerations compared to on-formulary medications.
The cost estimate information displayed is based on the patient’s prescription coverage benefits, and the medication, quantity, and pharmacy selected. Coverage, formulary and cost estimate information displayed is provided solely by the PBM and is not determined by Elation. Cost estimate information may include the estimated cost of the medication, cost breakdowns, coverage limits, prior authorization needs, and alternative options.

What information in Elation is used to retrieve coverage information?

Medical insurance information saved in the patient’s demographics is not used for prescription coverage, formulary, and cost estimate queries.

The following patient information is used to retrieve coverage information in Elation:

Legal First Name
Legal Last Name
Date of birth
Sex at birth

Am I required to enter a patient’s insurance details in Elation in order to retrieve prescription coverage information? You do not need to enter a patient’s insurance details in order to retrieve prescription coverage information. However, best practice is to store a patient’s insurance details in Elation, if a patient has insurance, to facilitate other workflows like billing or ordering diagnostic tests. What details are provided in the coverage information?

Place your mouse cursor over the PBM name to see additional coverage details, if available.

The COVERAGE section of the Prescription form tells you whether a patient has prescription benefits coverage and which Pharmacy Benefits Manager (PBM) covers the patient. Elation will show all prescription coverages available for the patient.

Place your mouse cursor over the PBM name to see additional coverage details, if available.

What information in Elation is used to retrieve formulary information? The following information is used to retrieve formulary information in Elation:

Patient’s coverage information
Medication name (as selected in the Prescription Form)

What details are provided in the formulary information?

Hover your mouse cursor over information badges or details with an asterisk to see additional details as provided by the PBM.Use the scroll bar to scroll up and down to see all the coverage and formulary information.

The COVERAGE section of the Prescription Form will list all formulary information as provided by the PBM(s). Formulary information can include any of the details listed below but not all details are always available from the PBM:

Formulary status
- Formulary status tells you whether a medication is potentially reimbursable by the patient’s insurance and whether the medication is preferred and/or on- or off-formulary. Click here to see a detailed description of each formulary status.
Copay tier
- The tier coverage is determined by the PBM and is organized from Tier 1 (more preferred) to lower tiers (less preferred). Tier 1 medications will generally be cheaper than Tier 2 medications and so forth. Tier coverage may also differ by pharmacy type (e.g. Retail vs Mail Order).
Medication type
- The formulary may categorize a medication by type (i.e. Prescription or Over-the-Counter) and note whether the medication is brand name or generic. Generic prescriptions are generally cheaper than their brand name counterparts.
Coverage factors and limits
- Coverage factors and limits disclose the terms and conditions in which the coverage applies. These include:
  - quantity limits
  - age limits
  - prior authorization requirements
  - step medication protocols
  - drug-specific resource links
Therapeutic or payer-specified alternative medications
- Any medications in the same drug group, class, and subclass as the medication selected are potentially therapeutic alternative medications.
- If a PBM provides information about payer-specified alternative medications, then only payer-specified alternative medications and their details will be returned and disclosed under COVERAGE, even if other therapeutic alternative medications exist. Therapeutic alternative medications that are at a lower coverage status (less preferred) than the selected medication will never be displayed.
- If payer-specified therapeutic alternative medications are not returned, Elation will display information about all therapeutic alternative medications that have an equal or higher coverage status (more preferred) returned by the PBM.

What information in Elation is used to retrieve cost estimate information? The following information is used to retrieve cost estimate information in Elation:

Patient’s coverage information
The following details from the Prescription Form:
- Medication name
- Medication quantity
- Days supply
- Pharmacy

Am I required to enter a patient’s insurance details in Elation in order to retrieve cost estimate information? You do not need to enter a patient’s insurance details in order to retrieve cost estimate information. However, best practice is to store a patient’s insurance details in Elation, if a patient has insurance, to facilitate other workflows like billing or ordering diagnostic tests. What details are provided in the cost estimate information?

If the patient has multiple coverages, Elation will by default display the cost estimate information for the first coverage listed. Select a different coverage to see the cost estimate information for that coverage.By default, the cost estimate information is for a 30 day supply. Enter a different number in the Days Supply field if you would like the cost estimate to be for a different days supply.If cost estimate information is unavailable you will see a note about this information being unavailable.

The COST ESTIMATE section of the Prescription Form will list all cost estimate information as provided by the PBM(s). Cost estimate information can include any of the details listed below but not all details are always available from the PBM.

Cost
- The cost of the medication as specified by the Payer.
Pharmacy Type
- The type of pharmacy that can be used to retrieve the medication (e.g. Retail or Mail Order) will be listed if coverage is available for more than one pharmacy type.
Coverage Limits
- Coverage limits disclose the terms and conditions in which the cost estimate applies. Hover your mouse cursor over the Limits tag to see the coverage factors and limits which can include:
  - quantity limits
  - age limits
  - usage recommendations & instructions
Prior Authorization Requirements
- A PA tag will tell you whether prior authorization is required for the payer to reimburse the selected medication. The cost estimate you see is the cost estimate of the medication after prior authorization is acquired. Hover your mouse cursor over the PA tag to see any additional details that may be provided.
Estimate patient pay breakdown
- Cost estimates may be broken down by the patient’s out-of-pocket responsibilities. Hover your mouse cursor over the cost to see any of the following details that may be disclosed:
  - Out-of-Pocket (OOP) applied
  - Out-of-Pocket (OOP) remaining
  - Deductible applied
  - Deductible remaining
Alternative medication options
- The PBM may return specific medications deemed by the PBM to be therapeutic alternatives. If the PBM provides cost estimates for alternative medications then the cost estimate information for all alternatives will also be disclosed under COST ESTIMATE in the Alternatives section.

I selected a medication but I do not see any cost estimate information for the medication. Why? To see cost estimate information for a medication, the patient’s Legal First Name, Legal Last Name, Date of birth, and Sex at birth must be in their demographics and the medication, quantity, and pharmacy must be selected in the Prescription Form. Enter the quantity and select a pharmacy and then you will see cost estimate information if any is available. Click here to understand the circumstances in which cost estimate information may not be available for patients without coverage information. Where does the coverage, formulary, and cost estimate information come from? The formulary and cost information comes directly from the patient’s Pharmacy Benefit Manager (PBM). After you select the medication, quantity, and pharmacy the information is sent along with the patient’s coverage to the patient’s prescriptions benefit plan and then the patient’s out-of-pocket prescription cost and associated details is then returned and displayed on the right side of the Prescription Form along with alternative therapeutic medication options, if available. Why is the prescription coverage different from the medical insurance coverage saved in the patient chart? Formulary and prescription cost estimate information is based on the patient’s prescription coverage and not medical insurance. Elation works with Surescripts to determine coverage and Surescripts works with Pharmacy Benefit Managers (PBMs) to understand formulary and cost estimation information. Why is prescription coverage information not available for one of my patients? Elation will query for patient prescription coverage every time the Prescription Form is opened. These are the most common reasons why prescription coverage may not be available:

The patient does not have active prescription coverage.
We could not find a patient match based on the demographics in the patient’s chart. Make sure the following information is in the patient’s demographics and then draft a prescription again or click Re-check coverage. Required fields are marked with an asterisk:
- Legal First Name*
- Legal Last Name*
- Date of birth*
- Sex at birth*
- Address (full address)
- Primary phone number
The patient’s benefit plan is not part of the network of available information. Elation works with Surescripts, who works with 99% of plans in the United States, and the patient’s plan might be in the 1% that is not part of the Surescripts network.

How does a Pharmacy Benefits Manager (PBM) contribute to the administration of prescription insurance benefits? A Pharmacy Benefits Manager (PBM) is a third-party administrator that manages prescription drug benefits on behalf of health insurance plans, employers, and government programs. PBMs maintain a list of approved medications, known as a formulary. The formulary is designed to include cost-effective and clinically effective drugs. PBMs negotiate with pharmaceutical manufacturers to include specific drugs in the formulary and secure favorable pricing for medications included in the formulary to reduce overall drug costs for the insurer and patients. Is prescription insurance benefits information available in the Elation Go mobile application? Prescription insurance benefits information is not available in the Elation Go mobile application at this time. We will notify you when we support this in the future. Do cost estimates include pricing with cash discount tools such as GoodRx? GoodRx and other cash pricing programs are not currently included in the cost estimate feature. We will notify you when we support this in the future. Does Elation’s prescription insurance benefits feature differ from other solutions like CoverMyMeds? Elation’s prescription insurance benefits feature and CoverMyMeds are both platforms that offer prescription insurance benefits information and both pull information from Prescription Benefits Managers. For these reasons, the information you see in Elation and CoverMyMeds should be the same.

Medication history & medication fill history download

What is the Medication History feature in Elation?	Medication History is the list of all medications ever documented or recorded in the patient’s chart, categorized into 3 categories (permanent, temporary or discontinued), and sorted by the date the medication was started.
Where can I see a patient’s medication history?	You can see the active permanent medications in Permanent Rx Meds and Permanent OTC Meds sections of the Clinical Profile. To see the full medication history, which includes temporary and discontinued medications, click Meds Hx in the gray navigation bar and then click Medication History.
What’s the difference between the Medication History feature and the Medication Lists in the patient’s Clinical Profile?	The Medication History(which can be found by clicking the Meds Hx button in the gray navigation bar at the top of the patient’s chart) is the patient’s full medication history as documented in Elation, including permanent, temporary and discontinued medications. The Medication Lists in the Clinical Profile only displays the permanent medications as documented in Elation.
What’s the difference between the Permanent Medication lists and the Scripts Since Last 6 Visits list?	The Permanent Medications List is a record of all of the medications marked as Permanent for a patient throughout their entire lifecycle as a patient in your practice. The Scripts Since Last 6 Visits lists any prescriptions that were ordered by your practice within the last 6 documented encounters and may only be a subset of the patient’s entire medication history.
What do the alerts for # fills received under the Outstanding Items section mean?	The alerts for # fills received under the Outstanding Items section is a report of the medication fill history download performed on the patient. The report displays the patient’s last 6 months of prescription fills as reported by the patient’s Pharmacy Benefits Managers (PBM). Click here for additional details about the medication fill history download feature.
What do I do with the # fills received notification in the Outstanding items section?	Providers should review the # fills received information and use the information to reconcile the patient’s Medication History as needed. To help you visualize the medication fill history, you will see the downloaded fills highlighted in yellow in the patient’s Medication List in the Clinical Profile as well as in the Medication History. The fill history is not a permanent part of your patient’s medication history until the fill is signed off by a provider. Click here for step by step instructions on how to reconcile downloaded medication fill history.
Why are some of the patient’s medications highlighted in yellow?	Downloaded medication fill history is highlighted in yellow to help you visualize the medication fill history against medications in the patient chart. The fill history is not a permanent part of your patient’s medication history until the fill is signed off by a provider. Click here for step by step instructions on how to reconcile downloaded medication fill history.
Can I download medication fill history for a patient?	Yes, Elation does have a feature for downloading medication fill history. Elation partners with Surescripts, an information technology company that supports electronic transmission of medical records, to retrieve prescription data from the patient’s Pharmacy Benefits Managers (PBM) - specifically data related to the patient’s last 6 months of prescription fills. This medication fill history includes medications that were prescribed by any of the patient’s providers. In order use the medication fill history download feature, the following requirements must be met: The Provider assigned in practice must have sent 5 prescriptions electronically through Elation • Patient charts must have the information in the patient demographics
How do I download medication fill history?	There are two methods for downloading medication fill history: Automatic download • Manual download
What does downloaded medication fill history look like?	Downloaded medication fill history will appear as a report in the Outstanding Items section of the patient’s chart. The report is titled … medication fills received. You can click on the title of the report to open the full report • in the Clinical Profile as medications with a yellow background. This indicates that updates regarding a medication have been found but the details are not a permanent part of your chart yet (ie the details are view only). You must sign off and import the medication history in order for the data to be a permanent part of your patient’s chart.
What’s the success rate of medication fill history downloads?	Only 60-70% of patients in a regular fee-for-service patient panel will have medications available for download. See the ‘Why is medication fill history retrieval unsuccessful for some patients?’ question for common reasons why medication fill history retrieval is unsuccessful.
Why is medical fill history retrieval unsuccessful for some patients?	These are the common reasons why medication fill history retrieval is unsuccessful for some patients: Surescripts does not have enough information about the patient, resulting in multiple patients that could match the criteria Elation sent to Surescripts. To avoid HIPAA violations, Surescripts defaults to not sending us information if there is ambiguity around whether we are referencing the same patient. • A patient just changed insurance plans (even if it is a different plan with the same insurer). All of this information depends on what information is stored by the patient’s insurance plan’s pharmacy benefits management system. If there is a change in insurer or pharmacy benefits manager (this is determined by the insurer or self-insured employer), the pharmacy benefits manager will not have the patient’s medication refill history because they just started managing that patient’s medication usage. • The patient has decided to pay for their prescriptions with cash instead of using their insurance to cover the bill. This results in the insurance company not having data about dispensed prescriptions. • The patient’s insurer is using a Pharmacy Benefits Manager (PBM) that is out of network with Surescripts. Approximately 99% of the PBMs in the USA participate in the Surescripts network.
How often can medication fill history be downloaded?	Automatic medication fill history is downloaded every 90 days per patient if they are scheduled in the Calendar. You can perform a manual download at any time for the most up to date medication fill history.
Why is the medication fill history download creating duplicate medications in the Medication List?	By default, downloaded medication fills are grouped together by the National Drug Code (NDC) code that may be supplied to us from the Pharmacy Benefits Manager (PBM) during the download. If the PBM did not share certain NDC codes with us then downloaded medications without NDC codes will not be grouped together. Click here to learn more about merging duplicate medications.
Who can sign off on medication fill hisotry downloads?	Only Provider Level Users or their prescription (Rx) delegates can sign off on downloaded medication fills.
Can I delete medication fill history download reports?	Medication history download reports cannot be deleted.
Which insurers or insurance plans are supported for medication fill history retrieval?	Since insurers can change pharmacy benefits managers or use multiple pharmacy benefits managers depending on the plan, Surescripts avoided making this system dependent on participating insurers. 99% of the pharmacy benefits management companies participate in the Surescripts network.
Can the Medication Fill History Download feature be turned off?	The Medication Fill History Download feature cannot be turned off. We recommend clicking the Sign off & Do Not Add to Med List option to store each download as a report. This option will keep the downloaded fill history separate from the medication list you have maintained.
Can patients opt-out of medication fill history download?	Yes, patients can opt-out of medication fill history download by emailing Surescripts at privacyofficer@surescripts.com. Once opted out at the Surescripts level, the patient’s medication history will not be shared with Elation or any other vendor using Surescripts for medication history.

In-house medications and injections

How do I document oral medications that were administered in the practice?	You can use the Instructions to pharmacy field in the Prescription Form as a note field to indicate that an oral medication was administered to the patient in the practice. After filling out the medication details, click Sign & Close to save the medication to the patient’s Medication History.
How do I document a medication that was administered to a patient through a needle and syringe (injectables)?	There are 3 options for documenting a medication that was administered to a patient through a syringe: Using the Instructions to pharmacy field as a note field in the Prescription Form. • Using the Vaccine Form. • Using a Visit Note Template. Click here to learn more about these 3 workflows.
Does Elation integrate with any inventory management softwares for me to track medications I dispense in house?	Yes, Elation integrates with the following two inventory management softwares: MDScripts • FlexScan For more information about how these integrations work and the cost of these integrations, please contact our Support Team using I need help -> Contact Elation Support.

Prescription monitoring for controlled substance prescriptions

Click here for the full Prescription Monitoring Program guide.

Does Elation connect with any prescription monitoring programs (PMP/PDMP)?	Elation has an integration with the Prescription Monitoring Programs (PMP/PDMP) of California, Illinois, Kentucky, Maryland, Utah, and Washington through LogiCoy, a Global Information Technology and Services integration partner.
Do I need to pay extra to connect with my state’s prescription monitoring program (PMP/PDMP)?	Elation will not charge customers for the setup or maintenance of the PMP/PDMP integration and states do not generally charge for the integration either. LogiCoy, our integration partner, does charge a yearly per-provider fee to maintain the integration at a special Elation rate. LogiCoy charges each full-time provider $40 per year and part-time providers$ 20 per year. Exceptions: Illinois - The state of Illinois is covering LogiCoy fees and Illinois providers will not be charged by LogiCoy or the state for the integration. • Washington - Washington requires an agreement with OneHealthPort (OHP), Washington’s HIE, before setting up a PMP integration.
Are PMP/PDMP integrations required?	Most providers are not currently required by their state to have a PMP/PDMP integration. The following states are exceptions: . Illinois- Providers based in Illinois are required to have a PMP integration as of January 1, 2022. • Washington- Practices with ten or more prescribers in Washington are required to have a PMP integration as of January 1, 2022.
Can I enable a PMP integration for multiple states?	Yes, PMP integrations can be set up with multiple states as long as Elation an integration with those states. Elation will query the correct PMP, if multiple PMP integrations are set up, based on the patient’s address.
Why is a PMP/PDMP integration not available for the state I practice in?	Elation is working on the capability to integrate with prescription monitoring programs (PMP/PDMP) in other states. You will be notified if and when a PMP/PDMP integration becomes available for the state you practice in.
How do I initiate a PMP/PDMP integration for one of the available states?	Follow the Setting up a PMP integration instructions in this article to initiate an integration.
How do I use the PMP/PDMP integration to view controlled substances that have been dispensed for a patient?	You can click the Check PMP button from one of the following places in a patient’s chart to see dispensed controlled substance prescription data from the PMP/PDMP integration: Under the Permanent Rx Meds section of the clinical Profile. • Click Meds Hx in the gray navigation bar at the top of the patient’s chart. • At the top of the Medication History window. A note will be left in the patient’s chronological record after a successful PMP check for documentation purposes. You can export this note to a visit note or to an office message for reference as needed.
Can staff use the PMP/PDMP integration?	At this time, Staff Level Users and Non-prescribing Provider Level Users cannot use the PMP/PDMP integration.
What happens if the PMP/PDMP check could not find the patient?	If there is no record of the patient in the PMP, a browser tab will still open in a new tab with a confirmation that no match was found. This is still a successful PMP check and a note will be recorded in the chronological record that a PMP check was performed.

Elation EHR

Getting Started

Clinical Workflows

Practice Operations

Admin & Compliance

Product Updates

Prescriptions Guide - Frequently Asked Questions

Documenting medications

Prescribing/ordering medications (general)

EPCS Registration & Account Management

Prescription Templates (Rx Templates) and Custom Rx Sigs

Drug decision support

Prescription insurance benefits

Medication history & medication fill history download

In-house medications and injections

Prescription monitoring for controlled substance prescriptions

​Documenting medications

​Prescribing/ordering medications (general)

​EPCS Registration & Account Management

​Prescription Templates (Rx Templates) and Custom Rx Sigs

​Drug decision support

​Prescription insurance benefits

​Medication history & medication fill history download

​In-house medications and injections

​Prescription monitoring for controlled substance prescriptions

​Related Articles

Documenting medications

Prescribing/ordering medications (general)

EPCS Registration & Account Management

Prescription Templates (Rx Templates) and Custom Rx Sigs

Drug decision support

Prescription insurance benefits

Medication history & medication fill history download

In-house medications and injections

Prescription monitoring for controlled substance prescriptions

Related Articles