## Qualifications

Low adherence opportunities are generated for patients filling diabetes, cholesterol, and/or hypertension medications with an adherence score 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%**. We follow the same format as CMS, where diabetes adherence is not calculated for patients on insulin. For hypertension adherence, we only include Renin Angiotensin System Antagonists.

## Using DPPR to calculate adherence

We use DPPR (daily patient possession ratio) to calculate adherence scores. DPPR is more accurate than the more commonly known measurement, PDC (proportion of days covered). If a patient is taking only one drug in a category, DPPR is equal to PDC. However, if a patient is taking more than one drug in a category, the DPPR adherence score will be more conservative (lower) than the PDC score.

The calculation also takes into account medications in the same drug class. This means that if a patient stops taking a medication in a certain therapeutic drug class (not category) and switches to a different drug in that same class or a different dosage of the same drug, their score should not be affected.

## Calculating the adherence score

*Step 1: Retrieve patient data*

We retrieve all **year-to-date refill data** for each patient. For example, a score calculated on October 1, 2019 will pull from information recorded between January 1, 2019 and October 1, 2019. **Exception**: During the first 3 months of the year, we'll show adherence scores reflective of the previous year. So, between January 1, 2020 - March 31, 2020, the adherence will be calculated by pulling data from January 1, 2019 - December 31, 2019.

As mentioned above, we retrieve refill information for diabetes, hypertension, and cholesterol medications. Drugs that are in the same class are counted as one; for example, if there are two drugs with three refills each, the total refills for this drug class will be six.

Drugs will be eliminated from the calculations if there are less than two refills in the given timeframe.

*Step 2: The DPPR formula*

In calculating the DPPR, we are ultimately generating an adherence percentage. The DPPR formula is:

DPPR = ((a + b + c) / (days covered)) * 100

To calculate the score, we need to explain and find the following:

**Days covered:** the number of days covered for a period when a patient has been taking medications. The calculation is:

Days Covered = Today – oldest refill date

**a/b/c:** the count of all days a certain number of medications are taken. The calculations are

a = (count of all days where 1 drug was taken) * (1/drug count)

b = (count of all days where 2 drugs were taken) * (2/drug count)

c = (count of all days where 3 drugs were taken) * (3/drug count)

**Drug count:** how many drugs are under one category

*Note: *if the count of drugs is less than three, the DPPR calculation will only include a and b.

## 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.