Qualifications

Low adherence opportunities are generated for patients filling oral diabetes, cholesterol, and/or hypertension (RASA) medications with a PDC between 60%-79% in at least one of the three categories. A patient is considered "adherent" if their score is greater than or equal to 80%.

Using PDC to calculate adherence

We use a modified form of PDC to calculate adherence We calculate PDC scores for all patients who have filled at least two drugs within a relevant therapeutic category on unique days since the first day of the current calendar year. Our calculation of PDC was adapted from the "Medication Adherence- Proportion of Days Covered" measure that was developed and is endorsed by PQA (Pharmacy Quality Alliance).

From January-March, we display the patient's adherence scores from the previous calendar year. Starting in April, we display the patient's adherence scores for the current calendar day.

The calculation also adjusts the measurement for overlapping medications with the same generic ingredient in the targeted therapeutic class. For example, if a patient fills a prescription for Lisinopril at one strength, and then soon after fills Lisinopril at a different strength, the overlapping days are shifted forward, and the patient's PDC is adjusted to account for the overlap. This also happens with combination products, as long as the generic ingredient in the targeted therapeutic class overlaps. An example would be a patient taking Lisinopril and then soon after filling a prescription for Lisinopril/HCTZ.

For any patients where their first fill of the applicable medication is in the last 90 days of the calendar year, a PDC for that drug class and that year is not calculated and their adherence for that therapeutic category is not included by plans when calculating store performance. For example, if a patient did not fill a statin all year, but filled Atorvastatin once in November and once in December of 2020, this patient meets the PQA exclusion criteria and would not have a statin PDC calculated for 2020.

For oral diabetes PDC, any patients who have filled insulin during the calendar year are excluded and will not have an adherence value calculated.

For hypertension/RASA PDC, any patient who has filled at least one prescription for sacubitril/valsartan (Entresto) in the calendar year are excluded and will not have an adherence value calculated.

Adherence Insights

To see an overview of your store's adherence performance, check out your Performance. For each medication category (cholesterol, diabetes, and hypertension), we calculate the percentage of patients who are considered "adherent" (adherence score >/= 80%). Hover your mouse over the circle to see the adherence score distribution among all of your patients in each category.

Review and take action on your patients who have low adherence to increase your performance and potentially lower your DIR fees. You will also be able to see your store's general adherence performance compared to the other pharmacies in your area.

What's Next? 

Learn more about your adherence metrics to help track and improve your pharmacy's performance measures.

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