## Qualifications

Low adherence opportunities are generated for patients filling diabetes, cholesterol, and/or hypertension medications with an adherence score in the range of 60% - 79% in at least one of the three categories. **A patient is considered "adherent" if their adherence is great than or equal to 80%**. We follow the same format as CMS where if a patient is on insulin, we do not calculate their diabetes adherence. 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 = 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 (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 refill data for each patient within a 365 days window; for example, when the score is calculated on June 1, 2018 we would retrieve information between June 1, 2017 and May 31, 2018. 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 3 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 where 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 we have under one category

*Note: *if the count of drugs is less than three, the DPPR calculation will only include a & 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 to potentially lower your DIR fees. You will also be able to see your store's general adherence performance compared to the other pharmacies that are in your area.

## What's Next?

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