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3.13.2015 High Risk Medication (HRM) According to the last paragraph on page 149, plans and POs should use the first two prescription fills to calculate average daily dose to determine numerator compliance. Should other fills during the treatment period be considered when calculating average daily dose?

Yes, all fills during the treatment period should be considered. Calculate the average daily dose for each High-Risk Medication fill using the formula (quantity dispensed x dose)/(days supply). If the average daily dose for any two fills of the HRM exceed the threshold, then the member is numerator compliant.

ALL 2014