Steve Zabriski, Pharmacist, MBA

Therapeutic Compliance

Calculating Medication Possession Ratio (MPR)

Steve Zabriski, Pharmacist, MBA

Background• Medication Possession Ratio (MPR) is widely accepted as a reflection

of a patient’s “compliance” with therapy especially for maintenance medications.

• Earlier methods of calculation were based on comparing the total days of therapy dispensed to the total number of days in a study period. This method often failed to account for “gaps” between refills.

• Computers can now be used to automatically evaluate each Rx claim for a patient to determine if gaps in therapy exist and/or if the patient is accumulating medication.

• This method can also be used to measure MPR differences among pharmacies or channels (Specialty, Retail, Mail).

Steve Zabriski, Pharmacist, MBA

MethodUsing desktop tools and PBM claim data:

• Evaluate Data – any analysis must start with “clean” data. Many claims (10% - 15%) can contain errant data i.e. “Days Supply”, metric qty, etc.

• Organize and properly sort.• Evaluate individual Rx claims.• Roll-up to patient-level summary.• Roll-up to population summary.

Steve Zabriski, Pharmacist, MBA

Sample Detail ReportMem_ID Phrm_Nm

Phrm Type Rx_Nbr NDC Prod_Nm Qty QTY2 DS_Old DOF DOF

Days Btwn DS

Fill Number Compliant

Days Missed

Tot Missed

Tot Days Reqd MPR % OnHand

A Specia l ty Phcy A S 6840231 68546031730 COPAXONE 1 1 30 7/28/2008 39657 30 1 Y 0A Specia l ty Phcy A S 6840231 68546031730 COPAXONE 1 1 30 8/28/2008 39688 31 30 2 N 2 0A Specia l ty Phcy A S 6955645 68546031730 COPAXONE 1 1 30 9/24/2008 39715 27 30 3 Y 3A Specia l ty Phcy A S 6955645 68546031730 COPAXONE 1 1 30 10/22/2008 39743 28 30 4 Y 5A Specia l ty Phcy A S 6955645 68546031730 COPAXONE 1 1 30 11/20/2008 39772 29 30 5 Y 6A Specia l ty Phcy A S 6955645 68546031730 COPAXONE 1 1 30 12/19/2008 39801 29 30 6 Y 7A Specia l ty Phcy A S 6955645 68546031730 COPAXONE 1 1 30 1/16/2009 39829 28 30 7 Y 9A Specia l ty Phcy A S 6955645 68546031730 COPAXONE 1 1 30 2/11/2009 39855 26 30 8 Y 13A Specia l ty Phcy A S 6955645 68546031730 COPAXONE 1 1 30 3/18/2009 39890 35 30 9 N 0 8A Specia l ty Phcy A S 6955645 68546031730 COPAXONE 1 1 30 4/21/2009 39924 34 30 10 N 0 4A Specia l ty Phcy A S 6955645 68546031730 COPAXONE 1 1 30 5/22/2009 39955 31 30 11 N 0 3A Specia l ty Phcy A S 6955645 68546031730 COPAXONE 1 1 30 6/19/2009 39983 28 30 12 Y 2 356 99.4% 5

Excel® and VBA (Visual Basic for Applications) was used to automatically evaluate each Rx claim for the patient to determine if therapy was missed or if he/she had adequate quantities “On Hand”. In this case, four of the 11 refills were “non-compliant” but in only one case (adjusting for shipping) did the patient theoretically not possess medication. In the other three instances (fills 9, 10, 11) the patient had adequate on-hand quantities. The result – the patient missed 2 / 356 days for an MPR of 99.4%.

This automated solution evaluated over 5,000 Rx claims for over 800 patients in under 20 seconds saving both time and money while providing robust clinical measurement.