E-Prescribe

Introduction

The Clinical Platform includes electronic prescribing (eRx) in the patient chart — NewRx, refills, changes, cancels, compounds, and controlled substances over the Surescripts network. Any pharmacy enrolled in Surescripts is reachable from Avara.

Avara eRx is the most modern e-prescribe experience on the market for any EHR. The prescribing UI is built for speed and clarity, and the platform runs reconciliation logic other EHRs do not support — inbound refill and change requests match back to the original prescription, and unmatched pharmacy traffic lands in an inbox your team can resolve instead of disappearing.

It is also the cheapest eRx on the market: $75/month per prescribing provider per organization, plus $50/month per prescribing agent per organization. See Pricing.

Pricing

$75/month per provider with Can Prescribe (Rx) at that organization.

That fee covers Surescripts network access and EPCS (electronic prescribing of controlled substances). You pay per provider, per organization — a provider enabled at two organizations is two seats.

$50/month per prescribing agent at that organization. Agents authorized at two organizations are two seats. Referral agents (Connect sending agents) remain free.

Nurses and other staff who are not prescribing providers and are not prescribing agents are not billed as eRx seats.

Clinic enablement is irreversible. Billing follows active Can Prescribe grants and active prescribing-agent authorizations. See Getting Set Up.

Getting Set Up

eRx takes three layers. Permission without self-enable does nothing; self-enable without permission does nothing.

1. Enable eRx for the clinic

Admin or owner users turn on eRx under Settings → Organization configuration. The organization’s name, street address, city, state, ZIP, and clinic contact phone must be complete first.

Confirm the address before you enable. Once eRx is on, you cannot disable it for the organization, and that address cannot be changed.

2. Grant prescribing permissions

Invite or edit the provider under Users. Two permissions apply:

• Can Prescribe (Rx) — electronically prescribe medications. Requires an NPI and a provider role.
• Can EPCS — electronically prescribe controlled substances. Requires Can Prescribe (Rx). Grant this only to providers cleared to write CS for your organization.

You control whether a given prescriber can write controlled substances, non-controlled only, or not prescribe at all. There is no separate clinic-wide CS kill switch — withhold Can EPCS for providers who should not write controlled substances.

3. Enable prescribing on the profile

Each provider turns on their own prescribing profile under Profile → Rx & Referrals. That step is independent of the organization grant and cannot be turned off once enabled.

The provider needs a complete prescribing profile: provider status, valid NPI, name, date of birth, phone, and address.

A valid state medical license is required to prescribe (Can Prescribe / eRx). Add it on the profile before enabling. A valid DEA license for this organization is required to enroll in EPCS and prescribe controlled substances. Both licenses live on Profile → Rx & Referrals (and credentials) after enablement.

Controlled Substances and EPCS

EPCS is required to send controlled substances electronically. Enrollment is available when the organization has granted Can EPCS and the provider has a valid DEA license for that organization.

Enrollment

Set aside about 15 uninterrupted minutes. You will need:

• The Duo Mobile app
• A cellphone for SMS (identity proofing and Duo)
• A driver’s license (photos and a selfie)
• A credit card (not debit) for identity verification
• Your Social Security number — identity proofing runs a soft credit check through Experian. You must know your SSN to complete that step.

The wizard covers legal agreements, identity proofing, knowledge-based verification, and two-factor setup. You create a 4-digit EPCS PIN (not 1234, not four identical digits) and enroll Duo on the phone.

Sending a controlled substance

Once enrolled, signing and sending a controlled-substance prescription requires:

1. Your EPCS PIN
2. A 2FA push approval on the Duo app on your mobile device

The send waits on that approval. You can view or change the PIN later from Profile → Rx & Referrals.

Prescribing agents cannot send controlled substances and cannot approve controlled-substance RxChange requests. See Prescribing Agents.

Prescribing Agents

Providers who have enabled eRx can authorize prescribing agents — non-provider staff without an NPI — to send non-controlled prescriptions on their behalf at that organization. Each authorized prescribing agent is $50/month at that organization.

Agents need a complete profile (date of birth, phone, and address). The provider manages the authorized list from Profile → Rx & Referrals. When an agent writes an Rx, they choose which authorized prescriber they are sending for.

Agents never enroll in EPCS and never send CS. Referral agents used for Connect referrals are a separate, unpaid role.

Writing a Prescription

Open New Rx from the patient chart. The patient must have the demographics the network requires (name, date of birth, phone, and address; height and weight if they are 18 or under) before you can start.

From there you can:

• Search and prescribe coded medications
• Build compounds (up to five ingredients — coded search or free text)
• Attach up to four ICD-10 diagnoses
• Report an existing outside or paper prescription without transmitting to a pharmacy

Review, interactions, and allergies

Before send, the review step runs allergy and drug-interaction checks. Chart allergies, clinic-written prescriptions, and patient-reported / externally recorded medications all feed the same interaction engine. Intake forms can prefill medications and allergies so that list is already in the chart when you prescribe.

Pharmacies

Pharmacy search reaches any pharmacy enrolled in the Surescripts network. Each result shows the message types that pharmacy supports — so you can see NewRx, refill, RxChange, cancel, fill status, eligibility, prior auth, and EPCS capability before you pick it.

Patients can keep favorite pharmacies. Those favorites are offered first on the next New Rx.

Favorites

Save prescription favorites and compound favorites for the clinic under Templates → Rx Favorites. They autofill medication and sig fields on the next New Rx. Pharmacy, effective date, and diagnoses are not stored on the favorite — those stay visit-specific.

After You Send

Avara supports the message types practices use day to day:

• NewRx — transmit a new prescription
• Cancel — cancel request to the pharmacy
• Refill / renewal — approve, deny, or replace
• RxChange — approve, deny, or modify a pharmacy-initiated change
• Fill / status — inbound pharmacy updates
• Prior authorization — initiate and track ePA where the pharmacy and plan support it

Pharmacy search displays those capabilities per pharmacy. A pharmacy that cannot accept EPCS or cancel, for example, is visible before you send.

Reconciliation

When a pharmacy sends a refill or change, Avara matches it to the original prescription. That inbound traffic does not vanish into a vendor portal.

If a request cannot be matched automatically, it appears on Rx Overview as an unmapped event. Your team can map it to a prescription or dismiss it. That inbox — plus matching refill and RxChange queues in the chart — is the reconciliation layer most EHRs do not give you.

Rx Overview is also the clinic-wide view of prescriptions, filters, and outstanding pharmacy requests.

Compliance

Avara eRx is certified by Surescripts for network prescribing and by Drummond Group for electronic prescribing of controlled substances. EPCS in Avara uses identity proofing, a PIN, and Duo two-factor approval as described in Controlled Substances and EPCS.

DEA registrations are stored per organization. The platform flags licenses that are nearing expiration.

For permission design, see Inviting Users — Can Prescribe and Can EPCS.