SCRIPT Standard 2023011 delivers one of the most significant updates to e-prescribing in years, introducing structural and functional changes that strengthen interoperability, elevate data accuracy, and support more clinically relevant exchanges. These are not surface-level adjustments; they redefine how prescription information is communicated across the healthcare ecosystem.
From entirely new message types to richer patient and clinical data fields, SCRIPT 2023 expands the standard into a more complete and expressive language for electronic prescriptions. These enhancements go far beyond a simple schema update, enabling safer workflows, more transparent communication, and better alignment with today’s prescribing realities.
Below is a breakdown of the major upgrades and how they enhance the experience for vendors, prescribers, and pharmacies.
Expanded Message Types
One of the most visible changes in SCRIPT 2023 is the introduction and refinement of several message types (including RxTransfer, RxRenewal Response, CancelRx, and RxChangeRequest) which were absent or limited in the prior 2017071 version.
These additions give systems more granular control over the entire prescription lifecycle, from initiating new prescriptions to handling renewals, cancellations, and pharmacy-to-pharmacy transfers. For example, SCRIPT 2023 provides explicit support for the RxTransfer transaction, enabling pharmacies to electronically transfer prescriptions to another pharmacy (even for controlled substances). This creates a more complete and traceable chain of communication. Instead of relying on phone calls or faxes for transfers or refill responses, pharmacies and prescribers can manage these tasks through standardized electronic messages.
Together, these enhanced message types create safer, more reliable workflows that reduce administrative friction for prescribers and pharmacies. As these workflows become more robust, the data carried within them also needed to evolve to support clearer and more complete clinical communication.
Enhanced Data Fields
The new standard isn’t just adding messages; it’s adding depth to the data within those messages. More specifically, SCRIPT 2023011 expands the type of patient demographic and clinical information that can be conveyed. For instance, there are now fields for a patient’s gender identity and pronouns, additional contact information types, and even patient conditions or allergies relevant to prescribing.
It also broadens the repertoire of drug identification, accommodating more precise identifiers and codes. Together, these updates support more accurate clinical documentation and interoperability. A prescriber can now communicate nuanced details (like a patient’s preferred name or specific allergy reactions) in the prescription message itself, rather than relying on free-text notes.
For specialty medications and complex dosing scenarios, the expanded fields ensure that essential context and detailed SIG instructions follow the prescription throughout the workflow, improving clarity and reducing the risk of misinterpretation.
With this richer and more detailed information flowing through the system, the next logical step became enabling smoother communication loops between prescribers and pharmacies.
Bidirectional Communication
Historically, e-prescribing transactions were often one-way: the prescriber’s system sent a prescription, and that was largely the end of it, aside from separate refill request loops. SCRIPT 2023 changes that paradigm by enabling true two-way dialogue between prescribers and pharmacies. Think of it less like a dispatched order and more like an ongoing conversation. Pharmacies can not only send refill requests but also communicate back statuses and changes in real time, and prescribers can answer with structured responses.
An example of this is the introduction of the new “pending” status in renewal function, which allows a prescriber to acknowledge a request and indicate that a decision is in progress. Features like these create faster feedback loops: pharmacist can now ask via an electronic message if a cheaper generic is acceptable, and the prescriber can reply electronically without ever picking up the phone.
By expanding these communication pathways, SCRIPT 2023 shortens turnaround times, reduces interruptions, and improves coordination across care settings, ultimately helping patients receive medications faster and with fewer delays. This improved communication framework also created a stronger foundation for modernizing one of the most challenging administrative processes in healthcare: prior authorization.
Electronic Prior Authorization (ePA)
Anyone in healthcare knows that prior authorizations (PAs) can be a source of frustrating delays. SCRIPT 2023011 tackles this head-on by significantly expanding support for electronic prior authorization within the prescribing standard. The new version introduces dedicated message types and fields to capture PA requirements, including structured fields for denial reasons, clinical rationale, and even attachments (supporting documents like lab results or chart notes).
In earlier standards, much of the PA process might happen outside the prescription messaging (e.g. through payer portals or faxes). Now it’s more tightly integrated: a prescriber’s system can send an electronic PA request and receive a response via standard SCRIPT messages. The standard even accounts for conveying why a PA was denied (for example, “step therapy required” or “need medical rationale”) in a codified way.
This added structure makes the PA process more automatable and transparent. Prescribers benefit by getting clearer, faster feedback from payers (often within their EHR workflow) instead of cryptic fax responses. Patients benefit by experiencing fewer delays at the pharmacy counter because PA approvals (or next steps) come through more quickly.
These enhancements turn prior authorization into a faster, more transparent exchange, benefiting both providers and patients by reducing delays at the pharmacy counter. Taken together, these workflow improvements lead naturally into the strengthened security controls that SCRIPT 2023 introduced for controlled substance prescribing.
Controlled Substance Messaging
Controlled substance e-prescribing has always required extra care for security and compliance. SCRIPT 2023 delivers important updates to support Electronic Prescriptions for Controlled Substances (EPCS) workflows. First and foremost, the new standard now explicitly allows electronic transfer of controlled substance prescriptions between pharmacies (a capability previously unavailable).
This is a big win for patient convenience (no more paper handoffs for a transfer). To that end, SCRIPT 2023 aligns with DEA and NIST guidelines by incorporating fields for enhanced digital signatures and prescriber identity proofing within the message structure.
In practical terms, the messages themselves can now carry evidence that the prescriber’s identity was verified to a trusted level and that the prescription content has not been altered. Additional metadata strengthens audit trails, helping systems log and trace every controlled substance prescription event from initiation to fulfillment.
For EPCS-certified vendors, these refinements preserve compliance while enabling a broader set of secure, patient-friendly workflows. Together, these updates reinforce a clear trend throughout SCRIPT 2023: the industry is moving toward more structured, interoperable, and clinically aligned prescribing processes that support safer and more predictable medication management.
The Bigger Picture — What It All Means
The shift to SCRIPT 2023 represents more than a technical uplift; it signals a broader evolution in how the industry expects prescription information to function. As workflows become increasingly interconnected and data-driven, the standard now reflects the level of structure, clarity, and precision that healthcare organizations rely on. For vendors, understanding these updates is not just about meeting requirements; it’s about anticipating how prescribing interactions will mature and how expectations around transparency, completeness, and consistent data exchange will continue to rise.
Rather than seeing SCRIPT 2023 as a collection of isolated changes, recognizing the themes behind the updates such as greater clinical context, cleaner communication, and more structured detail provides valuable insight into where e-prescribing is headed. This perspective gives teams a clearer foundation for long-term planning, helping them design solutions that align with emerging industry needs, reduce future rework, and position their products for stronger interoperability and market trust.