MedicationRequest.status and refill authorization requests

The current documentation for MedicationRequest.status differentiates “draft” vs. “active” as follows:

  • active - The prescription is ‘actionable’, but not all actions that are implied by it have occurred yet.
  • draft - The prescription is not yet ‘actionable’, e.g. it is a work in progress, requires sign-off, verification or needs to be run through decision support process.

In the scenario that a pharmacy user/system is sending refill authorization request (RAR) to a prescriber user/system, should both the pharmacy side and the prescriber side consider the the MedicationRequest as having a ‘draft’ status until the refill request has been approved?

What is throwing me off is the term ‘actionable’. Whether a MedicationRequest is ‘actionable’ seems to depend on the perspective of the person involved. e.g. from a prescriber’s perspective, every inbound MedicationRequest from a pharmacy is ‘actionable’. It needs to be reviewed and approved or denied.

A request for a refill is actually an ‘active’ proposal - i.e. MedicationRequest.intent=proposal. (Alternatively, it could just be a Task referencing the original prescription.) The prescriber would then create an ‘active’ MedicationRequest with an intent of ‘order’ based on the proposal. (In some cases, a nurse or resident or even their EHR might create the MedicationRequest with an initial status of ‘draft’ first.)