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Table 2 Description of drug count measures and impact of single component variations on drug count

From: Application of a framework for determining number of drugs

Variant # and label Scopea Uniquenessa Timeframea Drug counts for hypothetical patientb Drug count percentiles: 25th, 50th, 75th, 95th Proportion (%) of beneficiaries with a change in drug count from default: no change, 1 drug, ≥2 drugs
Default Conceptual definition: Prescription drug products Operational criteria: Included products flagged as being prescription drugs. All values for remaining subcomponents were included Conceptual definition: Product-based approach Operational criteria: Counted unique drug products at the ingredient(s)-route-form level by counting a combination product once, regardless of the number of ingredients in the product Conceptual definition: cross-sectional: the day of hospital admission for AMI, labeled as the index date Operational criteria: counted drugs where the observed index gap was less than a flexible allowable index gap of the days supply 3 2, 4, 6, 11
1. Rx and OTC products Conceptual definition: Prescription and over-the-counter drug products Operational criteria: Included products regardless of whether they were flagged as being prescription or over-the-counter drugs    3 2,4, 6, 11 97, 3, <1
2. Oral Rx products Conceptual definition: Orally administered prescription drug products Operational criteria: Included products flagged as prescription drugs and labeled with an oral route of administration    2 2, 4, 6, 10 74, 18, 9
3. Non-topical Rx products Conceptual definition: Prescription drug products administered via any route except for topical application Operational criteria: Included products flagged as prescription drugs and labeled with a non-topical route of administration    3 2, 4, 6, 11 96, 3, <1
4. Regularly used Rx products Conceptual definition: Prescription drug products that are commonly used on a regular basis Operational criteria: Included products flagged as prescription drugs but excluded products identified by Lund and colleagues as commonly used “as needed” [10]    3 2, 4, 6, 10 80, 17, 4
5. Ingredient-based at ingredient level   Conceptual definition: Ingredient-based approach Operational criteria: Dissected drug products into ingredients and counted unique ingredients at the ingredient level by counting the same ingredient once, regardless of route or how many products contained the ingredient   4 2, 4, 7, 11 70, 24, 5
6. Ingredient-based at ingredient-route level   Conceptual definition: Ingredient-based approach Operational criteria: Dissected drug products into ingredients and counted unique ingredients at the ingredient-route level by counting the same ingredient-route pair once, regardless of dosage form or how many products contained the ingredient-route pair   4 2, 4, 7, 11 71, 24, 5
7. Index gap: DS * 1.2    Conceptual definition: cross-sectional: the day of hospital admission for AMI, labeled as the index date Operational criteria: counted drugs where the observed index gap was less than a flexible allowable index gap of 1.2 times the days supply 3 2, 5, 7, 11 71, 18, 11
8. Index gap: fixed, 90 days    Conceptual definition: cross-sectional: the day of hospital admission for AMI, labeled as the index date Operational criteria: counted drugs where the observed index gap was less than a fixed allowable index gap of 90 days 4 3, 6, 9, 15 27, 20, 53
9. Index gap: fixed, 180 days    Conceptual definition: cross-sectional: the day of hospital admission for AMI, labeled as the index date Operational criteria: counted drugs where the observed index gap was less than a fixed allowable index gap of 180 days 4 5, 8, 12, 19 14, 13, 73
10. Post-index, first fill: pre-post fill gap: DS * 2    Conceptual definition: cross-sectional: the day of hospital admission for AMI, labeled as the index date Operational criteria: considered fills after the index date. Counted drugs where the observed index gap was less than a flexible allowable index gap of the days supply. Also counted drugs that did not meet this criterion but met the following criterion: the observed pre-post fill gap was less than the flexible allowable pre-post fill gap of 2 times the days supply 3 2, 4, 7, 11 75, 17, 9
11. Prior fill history: 180 day cabinet supply    Conceptual definition: cross-sectional: the day of hospital admission for AMI, labeled as the index date Operational criteria: considered the prior fill history. Counted drugs where the observed index gap was less than a flexible allowable index gap of the days supply plus the drug supply on-hand accumulated from all the fills 180 days before the last fill prior to index 3 2, 4, 7, 11 88, 9, 3
12. Other: hospitalization adjustment: during index gap    Conceptual definition: cross-sectional: the day of hospital admission for AMI, labeled as the index date Operational criteria: adjusted for hospitalization that occurred during the observed index gap. The rationale is that during hospitalization, the home drug supply is not used because the beneficiary’s drugs are provided by the hospital, and this should be accounted for when determining the allowable index gap. Counted drugs where the observed index gap was less than a flexible allowable index gap of the days supply plus the number of inpatient days during the observed index gap 3 2, 4, 7, 11 93, 4, 3
13. Other: PRN adjustment: fixed index gap, 180 days    Conceptual definition: cross-sectional: the day of hospital admission for AMI, labeled as the index date Operational criteria: counted drugs where the observed index gap was less than a flexible allowable index gap of the days supply or, for drug products commonly used on an “as needed” basis, where the observed index gap was less than a fixed allowable index gap of 180 days 4 2, 5, 7, 12 60, 27, 13
14. Other: dosage form adjustment: metered-dose inhalers, fixed index gap, 180 days    Conceptual definition: cross-sectional: the day of hospital admission for AMI, labeled as the index date Operational criteria: counted drugs where the observed index gap was less than a flexible allowable index gap of the days supply or, for metered-dose inhalers, where the observed index gap was less than a fixed allowable index gap of 180 days 3 2, 4, 7, 11 93, 6, 1
  1. aBlank column indicates component unaltered and as specified for the default
  2. bDrug counts based on fill history for hypothetical patient (Table 3)