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Johns Hopkins Health Plans

MAH - Medication Adherence for Hypertension RAS antagonists

Product Lines:
Advantage MD Part D. 

Measurement Period: January 1 - December 31

Description:
The percentage of plan members with a prescription for a blood pressure medication who fill their prescription often enough to cover 80% or more of the time they are taking the medication.

RAS antagonist medications include:

  • Angiotensin-converting enzyme inhibitors (ACEI)
  • Angiotensin receptor blockers (ARB)
  • Direct renin inhibitors

Note: The Part D Medication Adherence measure is adapted from the Medication Adherence-Proportion of Days Covered measure that was developed and endorsed by the PQA.

Measure Reporting:
CMS Start Rating Measure. 

Improvement Notation:
Increased score indicates improvement.

Data Collection:

  • Prescription Drug Event (PDE).

Initial Population:

  • Measure Item Count: Prescription Drug Event. 
  • Age: 18 years and older during the measurement period.
  • Benefits: Medical and pharmacy.
  • Continuous Enrollment: The treatment period.
  • Allowable gap: None.

Definition:
This measure is defined as the percentage of Medicare Part D beneficiaries, 18 years and older, who adhere to their prescribed drug therapy for renin angiotensin system (RAS) antagonists: ACEI, ARB, or direct renin inhibitor medications. 

The proportion of days covered (PDC) is the percentage of days in the measurement period “covered” by prescription claims for the same medication or another in its therapeutic category. 

The index prescription start date (IPSD) is the earliest date of service for the target medication during the measurement year. 

The treatment period begins on the IPSD and extends through whichever comes first: the last day of enrollment during the measurement year, death, or the end of the measurement year. 

The treatment period must be at least 91 days during the measurement year. 

Continuous enrollment (CE) is defined as being continuously enrolled in a Medicare Part D contract during the treatment period with no enrollment gaps allowed during the treatment period.

Denominator:
The percentage of Medicare Part D beneficiaries, 18 years and older, with at least two RAS antagonist medication fills on unique dates of service during the measurement period, and a treatment period that is at least 91 days during the measurement year.

Members qualify for the measure with the second fill, but the measurement period starts with the date of the first fill. To be included in the measure, the first fill of medication must occur at least 91 days before the end of the enrollment period.

Numerator:
The number of continuously enrolled beneficiaries, 18 years and older, with a PDC of 80 percent or higher for RAS antagonist medication during the measurement period.

Best Practice and Measure Tips

  • Improve Medication Adherence:
    • Is treatment appropriate? Should therapy continue? Follow-up to assess how the medication is working.
    • Use prescription benefit at the pharmacy. Only prescription fills processed with a member’s health plan ID card can be used to measure a member’s adherence.
    • For members who are non-compliant, provide ongoing patient outreach and identify reason for non-compliance and attempt to resolve.
    • To help member commit to taking their medication, use motivational interviewing and set goals for taking their medications.
    • Implement practice processes that can identify opportunity to close gaps every time the patient is seen.
    • Simplify the regimen. Complex medication schedules are a major barrier. Whenever possible, consider prescribing medications that are easier to manage—like once-daily doses, combination pills, or medications that can be taken with food.
    • Involve Family and Caregivers. Having a support system can make a world of difference. Involve family members or caregivers in the discussion to help create a consistent, supportive environment for the patient.
    • Reinforce Positive Behavior. When patients adhere to their medication regimen, celebrate those small wins. Positive reinforcement helps to build trust and motivates them to stay on course.
    • Encourage member to join refill reminder program at their pharmacy, if available.
    • Encourage mail order pharmacy program.
  • Talk with members about:
    • Why they are on a medication, the importance of taking medication as prescribed and timely refills. Confirm instructions.
    • Any barriers? Are there concerns related to health benefits, side effects or cost? Any problems getting medications from pharmacy?
    • Develop a medication routine with each patient if they are on multiple medications that require them to be taken at different times.
    • Encourage members to utilize pillboxes or organizers.
    • Advise members to set up reminders or alarms for when medications are due.
    • Adjust the timing, frequency, amount and or dosage when possible to simplify the regimen.
    • Discuss other factors that may improve symptoms, such as aerobic exercise and healthy diet or lifestyle changes.
    • Give members written instructions to reinforce teaching about the proper use of medication and what to do if they experience side effects.
  • Mail Order Pharmacy Program
    • Mail Order Best Practices
    • One of the most important ways to improve the health of our members is to make sure they receive and take their medications as you prescribe. Our mail order pharmacy, CVS/caremark, can help. CVS/caremark sends a three month supply of maintenance medications in one fill, making it easier for the patient only having to fill four times a year. In addition, a three month supply of maintenance medication on Tier 1 through 4 is available through CVS/caremark mail order at a reduced copay. This means your patient can fill a 100-day supply of Tier 1 medication and a 90-day supply of Tier 2 through 4 medication for only 2 times the retail copay—saving them an equivalent of four retail copays per year. Talk to your patients today about mail order pharmacy with CVS/caremark for better health and health care spending. Doctors and staff can contact CVS/caremark by calling the number below, 24 hours a day, seven days a week.

Measure Exclusions

Denominator Exclusions:

  • Beneficiaries in hospice or using hospice services any time during the measurement period.
  • End-stage renal disease (ESRD) or dialysis coverage dates any time during the measurement period.
  • One or more prescription claim for sacubitril/valsartan during the treatment period.

Exclusion Codes

ESRD ICD-10-CM: I12.0, I13.11, I13.2, N18.5, N18.6, N19, Z91.15, Z99.2

Measure Medications

Renin Angiotensin System (RAS) Antagonists Medication List

ACE Inhibitor Medications and Combinations

  • benazepril (+/- amlodipine, hydrochlorothiazide)
  • captopril (+/- hydrochlorothiazide)
  • enalapril (+/- hydrochlorothiazide)
  • fosinopril (+/- hydrochlorothiazide)
  • lisinopril (+/- hydrochlorothiazide)
  • moexipril (+/- hydrochlorothiazide)
  • perindopril (+/- amlodipine)
  • quinapril (+/- hydrochlorothiazide)
  • ramipril
  • trandolapril (+/- verapamil)

ARB Medications and Combinations

  • azilsartan (+/- chlorthalidone)
  • candesartan (+/- hydrochlorothiazide)
  • eprosartan (+/- hydrochlorothiazide)
  • irbesartan (+/- hydrochlorothiazide)
  • losartan (+/- hydrochlorothiazide)
  • olmesartan (+/- amlodipine, hydrochlorothiazide)
  • telmisartan (+/- amlodipine, hydrochlorothiazide)
  • valsartan (+/- amlodipine, hydrochlorothiazide, nebivololc)

Direct Renin Inhibitor Medications and Combinations

  • aliskiren (+/-  hydrochlorothiazide)