Rx360 — Surescripts Integration Strategy¶

Prepared by Gene Lang, PharmD | April 9, 2026 Based on: Surescripts meeting (April 9, 2026) + pharmacy operations analysis

1. The problem we're solving¶

Today, Rx360 connects to pharmacies one at a time. Each pharmacy runs different software (RX30, QS/1, PioneerRx, etc.), each requires a separate API integration, and each only sees prescriptions filled at that location. A patient who fills at CVS and an independent pharmacy has a fragmented medication profile in both systems.

Surescripts eliminates this. One connection = medication data from 99% of U.S. pharmacies for any enrolled patient.

2. What we confirmed in the Surescripts meeting (April 9)¶

Surescripts API integration IS feasible for Rx360's use case
The connection requires a provider, an encounter, and patient activity (refill, new Rx, etc.)
For our anchor clinical site pilot, these requirements are already satisfied: pharmacist = provider, onboarding = encounter, refill activity = ongoing trigger
For scale beyond pharmacy partners, we need an alternative trigger mechanism (health plan, ACO, RTM enrollment)
A demonstration environment showing the capability would strengthen the CVS/enterprise pitch

3. Recommended integration architecture¶

Phase 1: Anchor Site Pilot (Month 1–2)¶

Patient → Anchor Pharmacy (RX30) → Direct API → Rx360 Cloud → Wearable

Manual medication entry at onboarding, supplemented by RX30 data. This is what we're doing for the pilot. No Surescripts needed yet.

Phase 2: Surescripts via Particle Health (Month 3–5)¶

Patient → Particle Health API → Surescripts Network → Rx360 Cloud → Wearable
                              → Carequality
                              → CommonWell

Particle Health is already Surescripts-certified for Medication History for Populations. Estimated onboarding: ~12 weeks. Rx360 gets access to Surescripts + Carequality + CommonWell through one REST/JSON API. Requires a covered entity partner (pharmacy, health plan, or ACO) to satisfy Surescripts' provider/encounter requirement.

Phase 3: CMS Blue Button 2.0 for DTC (Month 3–5, parallel)¶

Medicare Patient → Medicare.gov OAuth → Blue Button API → Rx360 Cloud → Wearable

Patient self-authorizes. No provider, pharmacy, or encounter needed. Provides 4 years of Part D prescription claims for 64M+ Medicare beneficiaries. Free developer sandbox available now. This is the pure DTC pathway for seniors.

Phase 4: Direct Surescripts Certification (Month 6–12)¶

Patient → Rx360 (certified) → Surescripts Network → Rx360 Cloud → Wearable

Eliminates middleware costs. Requires NCPDP SCRIPT v2017071 implementation, security audit, and 4-phase certification. Timeline: 6–18 months. Build to newer NCPDP SCRIPT v2023011 standard (mandatory January 2028).

Phase 5: TEFCA Integration (Month 9+)¶

Patient → Rx360 → TEFCA QHIN → Surescripts + EHR data + Claims data → Rx360 Cloud

TEFCA sits above all individual networks. One agreement = medication data + clinical data (diagnoses, labs, vitals) from EHRs. This unlocks the full Beers criteria engine: medication risk + clinical context (e.g., warfarin patient + latest INR value).

4. Data available through Surescripts Medication History¶

Data field	Available?	Rx360 use
Drug name + NDC	Yes	Auto-populate medication schedule
Dosage form + strength	Yes	Verify correct medication
Quantity dispensed	Yes	Calculate days supply
Days supply	Yes	Predict refill gaps (72-hr warning)
Fill date	Yes	PDC calculation, adherence tracking
Sig (directions)	Yes (Premium: structured via Sig IQ)	Auto-generate dosing schedule and alert times
Prescriber NPI + contact	Yes	Escalation protocol
Pharmacy NPI + contact	Yes	Cross-pharmacy reconciliation
Refills remaining	Yes	Proactive refill reminders
New Rx notification	Yes (Populations)	Real-time medication updates
Refill nonadherence alert	Yes (Populations)	Predict and prevent gaps
Cash-pay purchases	Yes	Capture uninsured fills other systems miss

Key insight: The Premium Suite includes Sig IQ — machine learning that converts free-text prescription directions ("Take 1 tablet by mouth twice daily with food") into structured data. This is exactly what the wearable needs to auto-generate medication schedules without manual entry.

5. The CVS demo environment¶

The Surescripts meeting surfaced the idea of building a demonstration that shows CVS (or any enterprise partner) what the Surescripts-powered workflow looks like. This doesn't require live Surescripts access — it requires a simulated environment using realistic data.

What to build¶

A "sandbox" demo showing: 1. Patient enrolls → medication list auto-populates from simulated Surescripts feed 2. Medication schedule auto-generates on the wearable based on structured Sig data 3. Adherence data flows back → PDC calculates automatically 4. Pharmacist dashboard shows risk-stratified patient panel 5. Alert triggers when a refill gap is predicted or a new high-risk medication is added

How to build it¶

Use our anchor site's de-identified dataset as the realistic data source
Simulate Surescripts data format (NCPDP SCRIPT messages) using actual field structures
Build as a clickable prototype or live demo environment

When to show it¶

After anchor site pilot produces usability data (Pilot 1 complete, ~June 2026)
Package as: "Here's what we proved with manual entry. Here's what it looks like with Surescripts. You provide the covered entity relationship, we provide the technology."

6. Trigger mechanisms for Surescripts access at scale¶

Trigger	Provider	Encounter	Activity	Viable for Rx360?
Pharmacy partner (anchor site model)	Pharmacist	Onboarding visit	Refill pickup	Yes — but pharmacy-dependent
RTM enrollment	Prescribing MD/DO	RTM order	Device-generated data	Yes — if prescriber orders RTM
Medicare Advantage plan	Plan medical director	Member enrollment	Claims activity	Yes — strongest enterprise path
ACO care management	ACO provider	Care plan enrollment	Ongoing care coordination	Yes — if ACO distributes device
MTM provider	MTM pharmacist	CMR/TMR encounter	MTM referral	Yes — ties to Outcomes MTM strategy
Blue Button (bypass)	None needed	None needed	Patient self-auth	Yes — DTC only, Medicare beneficiaries

Recommended strategy: Start with pharmacy (anchor site pilot), layer Blue Button for DTC, then pursue MA plan partnerships for full Surescripts access at scale.

7. Cost estimates¶

Path	Setup cost	Per-query cost	Timeline
Particle Health	Integration fee (negotiable)	~$0.50–2.00/query (estimated)	12 weeks
Blue Button 2.0	Free (developer sandbox)	Free (CMS-provided)	1–3 months
Direct Surescripts	$50K–200K (engineering)	~$0.04–0.10/transaction	6–18 months
TEFCA QHIN	Varies by QHIN	Varies	9+ months

Note: Surescripts does not publish pricing. The per-transaction estimates are based on FTC case disclosures and industry sources. Actual costs are negotiated.

8. Competitive advantage¶

No wearable company has Surescripts integration. The competitive landscape:

Company	Medication data source
Medisafe	Manual entry + pharmacy portal scraping
Hero Health	Manual entry only
MedMinder	Manual entry only
CarePredict	No medication data — tracks ADLs only
Apple Watch	Apple Health manual entry
Rx360 (proposed)	Surescripts + Blue Button + pharmacy API

Rx360 would be the first medication adherence wearable with auto-populated, cross-pharmacy medication profiles. This is a defensible competitive moat.

9. One-line summary for Peyman¶

"Surescripts gives us every patient's complete medication list from every pharmacy in the country through one API. Nobody else in the wearable space has done this. The fastest path is Particle Health (12 weeks), and Blue Button lets Medicare seniors self-enroll without any pharmacy involvement at all."