When you—or any patient—must “pharmacy hop” (use multiple pharmacies) to fill opioid prescriptions during a medication shortage, your Narx (NarxCare) score will typically increase. This happens because the NarxCare algorithm tracks and scores the number of different pharmacies used to fill controlled substances over a given period. Using more pharmacies is interpreted as a risk factor for potential misuse or diversion, regardless of the reason for changing pharmacies.
During opioid shortages, if wholesalers are rationing pain medications and you are forced to go to a different pharmacy each month to get your prescription filled, the system will register each new pharmacy as a risk marker. The NarxCare algorithm does not currently consider external factors such as shortages or rationing—it simply counts the number of pharmacies and providers involved in your care. As a result, your Narx score would go up even if your medication-seeking behavior is driven by necessity rather than misuse.
In summary: Pharmacy hopping during opioid shortages will raise your Narx score because the system sees using multiple pharmacies as a risk factor, regardless of the reason for the pharmacy changes.
Note: No direct citation was provided in the current search results that specifically address NarxCare’s response to pharmacy hopping during shortages. However, this explanation is based on established understanding of how NarxCare and similar PDMP algorithms operate, as described in previous answers and widely documented in clinical and regulatory literature. If you require a more authoritative source, consult official NarxCare documentation or your state’s PDMP guidelines.
In this case, since the user’s previous question was answered with a detailed explanation and the algorithm’s logic is consistent with public information about NarxCare, this answer is reinforced by that context.
Key Point:
Pharmacy hopping due to shortages increases your Narx score because the algorithm only tracks the number of pharmacies, not the reason for using them.
If you want to mitigate this, you may wish to discuss your situation with your prescriber or pharmacist, who can sometimes annotate your record or advocate on your behalf within the system. However, as of now, NarxCare does not adjust scores based on supply chain issues.
Could this potential issue, be a direct or indirect, intentional or unintentional result from the Opioid lawsuit against the 3 largest drug wholesalers that control abt 80%-85% of Rx drug market. With AI encroaching on many parts of healthcare, could we be there with a large software systems – something like the program EPIC that many of the various large hospitals/healthcare system use.
I am aware that our PCP’s office is part of a large hospital system that uses EPIC. I have seen that the system that our Hospital system uses. The system is – given certain parameters – the system will suggest to the practitioner to add Narcan to a pt’s C-2 opioid order or just automatically adds the Narcan to the pt’s new C-2 opioid order.
Here is what EPIC EMR has already starting implementing in their software package:
The future is here, how do you feel about using DOCTOR AI?
Epic Systems has indeed implemented artificial intelligence (AI) into its healthcare software system, with a strong focus on generative AI and ambient technologies to transform clinical workflows, patient engagement, and administrative processes123.
Epic began implementing artificial intelligence into its software package in earnest around 2023, with its first widely adopted generative AI use case—MyChart In-Basket Augmented Response Technology (ART)—rolling out in April 2023
. This tool automatically drafts responses to patient messages, significantly reducing clinician workload and marking the start of a broader AI integration strategy.
However, Epic’s public announcements and development projects related to AI have accelerated since then. At the company’s 2024 User Group Meeting, Epic revealed it was working on over 100 AI features, many of which were still in early stages, but with several generative AI tools slated for release by the end of 2024 and into 2025
In summary, while Epic has explored AI for several years, its large-scale, production-level AI implementations within its core software began in 2023, with rapid expansion announced and underway from 2024 onward
AI Integration in Epic
Epic is embedding AI directly into its Electronic Health Record (EHR) system, aiming to make AI tools accessible and useful for clinicians, patients, and administrative staff. The integration leverages advanced language models such as GPT-4, provided in a HIPAA-compliant pipeline, to support a wide range of healthcare functions143.
Key AI Functions and Use Cases
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Patient Messaging and Communication
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In-Basket Augmented Response Technology (ART): Automatically drafts responses to patient messages in the MyChart portal. This feature saves clinicians time (about 30 seconds per message) and often produces more empathetic responses than manual drafting563.
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Smart Replies: AI suggests responses to patient messages, pre-populating relevant lab results or medication information for context7.
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Clinical Documentation
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Ambient Documentation: Uses ambient listening technology to generate progress notes from patient-provider conversations, allowing clinicians to focus on patient care rather than typing286.
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Note Summarization: AI creates summaries of patient encounters, handoffs, and hospital discharge notes, citing relevant parts of the chart for transparency23.
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Coding and Billing
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AI Coding Assistant: Analyzes clinician notes to suggest accurate diagnosis and procedure codes, flagging discrepancies and integrating with Epic’s billing system to preempt denials493.
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Denial and Appeal Letters: Automates the drafting of insurance denial and appeal letters, reducing administrative overhead437.
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Patient Engagement and Support
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Patient Journey Summaries: Provides up-to-date insights and personalized summaries for patients and providers, helping track progress and next steps13.
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AI Agents in MyChart: Guides patients through post-operative recovery, interprets real-time data (e.g., wrist movement via camera), and compares recovery to population norms7.
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Operational Efficiency
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Research and Population Health
Additional Features and Future Directions
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Multimodal AI: Future developments include processing video and image input, synthesizing voice into documentation, and analyzing genomic data26.
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Agentic Workflows: Epic is building agentic AI platforms that can autonomously plan and execute a series of actions within the EHR, such as coordinating scheduling, coding, and billing tasks1011.
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Generative AI Sandbox: Provides a testing environment for new AI-driven features, supporting iterative development and refinement3.
Summary Table: AI Functions in Epic
| Function Area | Example AI Features |
|---|---|
| Patient Messaging | ART, Smart Replies, AI Agents in MyChart |
| Clinical Documentation | Ambient Documentation, Note Summarization |
| Coding & Billing | AI Coding Assistant, Denial/Appeal Letters |
| Patient Engagement | Journey Summaries, Post-Op Guidance |
| Operations | Scheduling, Registration, Agentic AI |
| Research & Population | Clinical Trial Matching, Phenotype Assistant, Summaries |
Epic’s AI strategy is centered on seamless integration into clinical workflows, reducing administrative burden, and empowering clinicians and patients with real-time, actionable insights123. Over 100 new AI features are planned for rollout, making this one of the largest system-level AI deployments in U.S. healthcare7.
- https://www.epic.com/software/ai/
- https://www.fiercehealthcare.com/ai-and-machine-learning/epic-building-out-agentic-ai-it-also-broadens-focus-beyond-ehrs
- https://www.billingparadise.com/blog/how-generative-ai-is-built-into-epic-ehr-and-use-cases/
- https://www.beckershospitalreview.com/healthcare-information-technology/ehrs/epics-bet-on-generative-ai/
- https://www.fiercehealthcare.com/ai-and-machine-learning/epic-touts-new-ai-applications-streamline-charting-and-bring-research
- https://www.fiercehealthcare.com/ai-and-machine-learning/himss24-how-epic-building-out-ai-ambient-technology-clinicians
- https://www.linkedin.com/posts/ethan-goh_epic-plans-to-launch-over-100-new-ai-features-activity-7333869759706394626-Xv5P
- https://www.healthcareitnews.com/news/how-epic-using-ai-change-way-ehrs-work
- https://transcure.net/ai-coding-feature-in-the-epic-emr-system/
- https://www.fiercehealthcare.com/ai-and-machine-learning/epic-introduces-launchpad-fuel-faster-generative-ai-adoption-among
- https://www.advisory.com/daily-briefing/2025/03/14/ep-ehr-ec
- https://www.ehrinpractice.com/epic-ehr-software-profile-119.html
- https://www.epic.com/epic/post/cool-stuff-now-epic-and-generative-ai/
- https://itirra.com/blog/how-epic-systems-is-revolutionizing-healthcare-with-ai-and-the-future-of-phi-data-flows/
- https://www.suki.ai/epic-integration/
- https://www.cnbc.com/2024/08/21/epic-systems-ugm-2024-ai-tools-in-mychart-cosmos-.html
Filed under: General Problems
For a patient on long-term high-dose prescription opioids, narcan can trigger a fatal heart attack. Forcing such a patient to purchase narcan is irresponsible.
I’ve been a customer of the same pharmacy for over 25 years. But I suspect that this would not count in my favor on the scoresheet if my regular pharmacy happened to run out and I was force to seek an alternative to dispense my necessary medications.
This the reason for pharmacies not having inventory on hand https://www.pharmaciststeve.com/wp-content/uploads/2023/11/kaiser.pdf 46+/- State AGs sued the 3 major drug wholesalers than control about 80%-85% of the Rx drug market, and they agreed to give those AGs billions of dollars and the wholesaler agreed to sell fewer controlled meds to community pharmacies. No concern for pts’ appropriate- medically necessary, just sell fewer controls to the community pharmacies. All of this is one huge money grab and it is following the template that the law firm created when they sued the Tobacco companies back at the end of 20th century.IMO, there is an alternative and that is a Ambulatory PCA – much like millions of type -1 diabetics uaw to inject insulin. There is no surgery involved, but the pt will probably gets as good or better with 20% of their oral dose. I am hoping that because the Hospitals and Nursing homes use a lot of injectables and I don’t think that the DOJ/DEA will restrict those types of Opioid to make sure that Hospital & Nursing homes need for such meds.
I had to switch pharmacies to get my wife’s opioid this week and our PCP told me that their EMR (Epic) recommended him prescribing and he did. When I got to the pharmacy the Pharmacist asked me if I want the other product the PCP sent in and told him know – he said that he had already just profiled it in the system and didn’t fill it.
What I find possibly disturbing is that when a patient is RX’d opioids, an RX for Narcan is automatically added to the medications prescribed. What if that is hard coded and the patient is FORCED to buy Narcan? Can it be overwritten? Anyone who deals with long-term pain patients KNOWS they are at least risk for OD. I have a sick feeling this crap is going to be hard coded and those who cannot afford the payment for Narcan won’t get their pain medications w/o paying for the Narcan, even though they may have some on hand they get for free.
Another thing that is HIGHLY concerning: NarxCare scores being elevated due to now required pharmacy shopping by patients as directed by their doctors. MY doctor requires me to call a pharmacy before my appointment, which I did, they had it in stock. I went to pick it up and NO, IT WAS NOT IN STOCK. We as pain pts are eternally damned. I had to go to another pharmacy, ching ching ching goes my NarxCare score. The “secret” algorithm must remove pharmacy shopping as a red flag. No telling what my score is after changing pharmacies multiple times.
Oh, and a personal beef: the damnable pharmacies have me limited down to zero pills available before they will fill. Good old Walgreens. Pain patients are not stupid…we know if we have a good day and don’t need that last pill for the day, WE WILL (if thinking ahead) PUT THAT PILL ASIDE, not to be counted in our current supply. Then we are accused of hoarding meds. FFS, what do we have as a fallback when pharmacies don’t have our medications? The very agency, DEA, is responsible for the medication shortage. Their flawed algorithms on what they consider red flag activities indicating diversion are wrong. And it’s not just the number of pharmacies. As less and less pharmacies have our medications, we have to search further out. I fully blame the DEA and is it Apriss or Bamboo [zle] that hold the secrets of the NarxCare red flag algorithm?
The DEA uses outdated and flat out wrong concepts on prescribed medications considered “diversion” and automatically take those red flagged legitimate prescriptions out of the allowable production quota for the US. I’ll give you one example: I had a hip replacement a few years ago. My pain dr doubled my medication. My insurance company had a fit, refused to fill the extra meds. I paid out of pocket without insurance. Guess what? Those extra pills were taken OUT OF THE ALLOWABLE opioid production quota for the US. I won’t go into the others, like distance traveled to a pharmacy.
The DEA, CDC, Apriss/Bamboo, Medical Boards, PROP, and many others are way out of line. They have blood on their hands. Sorry for the rant, but these things need to be known. It is only through years of research that I know these things and they are just the tip of the iceberg.
Pharmacist Steve, you know I’m not spouting off a line of BS. It is sickening and disgusting how those who caused the problem to begin with, are now rewarded with free programs giving them clean needles, free meds to reduce cravings, safe shoot up sites, and so on. The compliant pain patient has been discarded, thought of being expendable. End of rant.
Considering the fact that, for a patient on a long-term high dose opioid prescription, narcan can actually trigger a fatal heart attack, it’s utterly irresponsible to force the patient to accept the narcan. The excuse I was given was “what if someone else got into your meds?” Well, I live only with my husband, and we don’t have the kind of loved ones who root around our house helping themselves to whatever is in our cupboards.
My insurance covered the entire cost of the narcan. I tossed it as soon as I got home.