Measures and Performance Calculations

EQUIPP® provides benchmarked data for standardized medication-related quality measures that are developed and endorsed by measure developers, according to CMS guidelines. The primary measure categories within EQUIPP include:

• Adherence Measures 
• Clinical Use Measures
• Specialty Measures
• Payer-Specific Program Measures

Adherence quality measures account for the majority of hosted patient data as these scores are based on an individual patient's adherence to their maintenance medications for specific disease states.

Please click here for a full list of the measures hosted in EQUIPP and measure-specific details and calculations! 

Overall Measure Performance Score 

• Measure performance scores are calculated according to measure specifications based on adjudicated prescription drug claims data, medical claims, and member eligibility data provided by health plans and pharmacy benefits managers.
• The overall measure score represents the percentage of patients that are meeting the intent of the measure. Please see the example below:     

Adherence Measure Details

Adherence Measure Patient Attribution - How are patients "assigned" to a pharmacy? 

• Patients are attributed to the pharmacy that filled the most prescription claims within the measurement period for the target therapeutic category
• If a patient fills the same number of prescriptions during the measurement period at multiple pharmacies, the patient will be attributed to the pharmacy that completed the most recent fill

Measure Qualification - How do patients qualify for an adherence measure?

The minimum requirements for a patient to be eligible for the adherence measures include:

• Patient must have at least two (2) fills in the measurement period –regardless of the days supply of the prescription fills.
• The first fill of the applicable medication (class) must be at least ninety-one (91) days prior to the end of the measurement period

Proportion of Days Covered (PDC) Methodology

• Proportion of Days Covered (PDC) is the percentage of coverage by prescription claims for the same drug or another drug in the same therapeutic class, within a calendar range for a specific patient. Clinical evidence supports the expected PDC threshold of 80% to be met for an attributed patient to achieve the best therapeutic benefit of an eligible medication.

PDC Score Calculation

• The PDC Score (Period of Days Covered) is the calculation of days covered by target medications from the first fill date until the end of the measurement period.  Please see the formula below:                                                         

• Days covered by a target medication
  • This is equal to the number of days covered by the target medication within the measurement period
  • The days covered by a target medication count towards being adherent with no overlap for days, therefore a patient cannot score higher than 100% PDC
• Days in measurement period
  • This is equal to the number of days between the date that the prescription is first filled during the measurement period through the last date of the measurement period

Measure Performance Score Key Details

• The performance scores reflect the percentage of adherent patients within the measurement period, whereas the PDC scores reflect medication adherence on an individual patient level
• Measure performance and PDC scores are calculated with adjudicated claims data and eligibility provided by health plans and pharmacy benefit managers
  • Cash, discount card, other non-adjudicated claims are not included in performance evaluations
• Calculations reflect claims data within the selected measurement period