Adherence is where pharmacy quality scores and clawback relief meet. PBMs and Medicare star programs reward pharmacies whose patients stay above 80% PDC on key chronic measures, and strong scores can mean lower DIR fees or quality bonuses — real money on top of dispensing. Alongside it, clinical services (immunizations, point-of-care testing, MTM) are a growing non-dispensing revenue line. This dashboard tracks both.
What this report answers
Are our patients adherent enough to earn the bonus, and what is clinical service adding? The Adherence (PDC) page leads with PDC-adherent patient count, adherence rate, gap-in-care count, MTM completion rate, clinical service count, and clinical service revenue, then shows adherence rate by measure — diabetes, hypertension, statin — against a constant star-threshold reference line, with gaps in care by measure. The Clinical Revenue page totals clinical service revenue by type and trends service volume.
The metrics that matter
Adherence rate is the headline — adherent patient-measures over eligible patient-measures, the PDC figure the star bonus is calculated on — and reading it against the 80% threshold line shows instantly whether each measure clears the bar. Gap-in-care count is the actionable list: patients with an open refill gap are the ones to call before they fall below threshold. MTM completion rate captures another quality lever, and clinical service revenue sizes the non-dispensing income.
Why the data is trapped across the systems
PDC is computed from refill timing across a patient's fills — a rolling, patient-by-measure calculation the dispensing system records but doesn't surface as a star-style rate against a threshold. MTM eligibility and completion, immunization and point-of-care billing, and the revenue from each sit in different parts of PioneerRx or Liberty and on the PBM remittance. Pulling adherence, gaps, MTM, and clinical revenue into one quality view is exactly the cross-system join owners can't do natively.
How to read it
Read each measure against the star-threshold line: a measure under 80% is bonus money at risk, and the gap-in-care list for that measure is the call list to fix it. Use MTM completion to find eligible patients not yet reviewed. On the Clinical Revenue page, the service-type mix shows where non-dispensing income is growing and where there's room. Adherence protects the bonus; clinical services build a revenue line that doesn't depend on dispensing margin.
The sample uses synthetic patient-measures and made-up revenue — no real PHI.
Metrics it tracks
| Metric | What it means |
|---|---|
| PDC-Adherent Patient Count | Patient-measures at or above 80% proportion of days covered (PDC). |
| Adherence Rate | Adherent patient-measures ÷ measure-eligible patient-measures — the star-bonus PDC rate. |
| Gap-in-Care Count | Patient-measures with an open refill gap — non-adherent or overdue. |
| MTM Completion Rate | Completed comprehensive medication reviews ÷ MTM-eligible patients. |
| Clinical Service Count | Billable clinical service rows — immunizations, point-of-care tests, MTM. |
| Clinical Service Revenue | Revenue from billable clinical services. |
Used by: Owner-pharmacists chasing DIR/star quality bonuses through PDC adherence, MTM completion, and clinical service revenue
Frequently asked questions
What is PDC and why is the 80% threshold important?
PDC (Proportion of Days Covered) measures how consistently a patient has medication on hand across a period. Star and quality programs generally count a patient as adherent at 80% PDC or above on key chronic measures, and pharmacy-level adherence rates feed bonus and DIR-relief calculations — so the 80% line is the bar each measure needs to clear.
How does adherence connect to DIR and star bonuses?
Many PBM and Medicare quality programs reward pharmacies with strong adherence scores through bonuses or reduced DIR fees. Tracking adherence rate by measure against the threshold — and working the gap-in-care list before patients fall below it — is how a pharmacy protects and improves that quality revenue.
Can I build this on my own dispensing and clinical data?
Yes. Export your fills with refill dates, your MTM eligibility/completion, and your clinical service billing and use this as a template — we model PDC adherence, gaps, and clinical revenue into a Power BI report. The sample uses synthetic data so there's no PHI here.
Build this report on your own data
Clone this Independent pharmacies template — describe it and we’ll generate sample data so you can try it free, or upload your own export. You get a fully modeled, branded Power BI project that opens in Power BI Desktop.
Use this as a template →