Measurement Period: January 1–December 31.

Description:
The percentage of persons, 40-75 years old, who were dispensed at least two diabetes medication fills on unique dates of service and received a statin medication fill during the measurement period.

This rating is based on the percent of plan members with diabetes who take the most effective cholesterol-lowering drugs.

* The SUPD measure is adapted from the measure concept that was developed and endorsed by the Pharmacy Quality Alliance (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: Members with diabetes ages 40–75 during the measurement year.
• Benefits: Medical and pharmacy.
• Continuous Enrollment: In Medicare Part D contract during the measurement period. Beneficiaries are only included in the measure calculation if the IPSD occurs at least 90 days before the end of the measurement period.
• Allowable gap: One allowable gap in enrollment of up to one calendar month.

Definition:
This measure is defined as the percentage of Medicare Part D beneficiaries, 40-75 years old, who were dispensed at least two diabetes medication fills on unique dates of service and received a statin medication fill during the measurement period.

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

Continuous enrollment (CE) is defined as being continuously enrolled in a Medicare Part D contract during the measurement period, with one allowable gap in enrollment of up to one calendar month. Beneficiaries are only included in the measure calculation if the IPSD occurs at least 90 days before the end of the measurement period.

Members with diabetes definition:
Those who have at least two fills of diabetes medications during the measurement year. To comply with this measure, a member with diabetes must have a fill for at least one statin or statin combination medication in any strength or dose using their Part D benefit during the measurement year.

Denominator:
Persons with at least two diabetes medication fills on unique dates of service during the measurement period and an IPSD that occurs at least 90 days prior to the end of the measurement period.

Numerator:
Persons who received a statin medication fill during the measurement period.

Best Practice and Measure Tips

• Prescribe at least one statin medication during the measurement year to patients diagnosed with diabetes.
• This measure overlaps with the Statin Therapy for Patients with Cardiovascular Disease measure. Patients with ASCVD should be prescribed a moderate-intensity or high-intensity statin.
• This measure overlaps with the Medication Adherence for Cholesterol (Statins) measure.
• Educate patients on the importance of statin medications for diabetic patients over the age of 40, regardless of LDL levels.
• Remind patients to contact you if they think they are experiencing adverse effects, such as myalgia. Consider trying a different statin that is more hydrophilic or reducing the dose or frequency.
• Member must use their insurance card to fill one of the statins or statin combination medications through the last day of the measurement year.
  • Gap closure depends on pharmacy claims.
  • Evaluate the appropriateness of prescribing a 90-day supply to optimize medication adherence and reduce refill frequency.
  • Consider including prescribing directives that instruct the dispensing pharmacy to adjudicate the claim through the patient’s pharmacy benefit plan. The use of discount programs, paying cash for medication and medication samples will not count toward gap closure.
• Educate members: Statin use should always be accompanied by lifestyle modifications focused on diet and weight loss to improve a patient's lipid panel.
• Experiencing adverse effects:
  • Instruct patients to contact their practitioner if they are experiencing adverse effects.
  • Document any adverse effects from statin therapy.
  • Determine if the signs/symptoms qualify as an exclusion.
  • Try reducing the dose or frequency or consider trying a different statin medication.
• Start the conversation early. Engage your patients in a discussion about the importance of the medication(s) at the first prescription - right from the beginning. Setting the stage early can foster a sense of ownership and responsibility, helping them stay committed.
• Encourage your patients to utilize technology. Medication reminder apps and digital health tools, in addition to pill boxes, can be incredibly effective in keeping patients on track.
• Monitor and follow up. Don’t wait for patients to report issues—proactively check in with them, whether through a follow-up call or appointment. Early intervention can prevent small issues from escalating into bigger problems.
• Ask about and address barriers head-on. Costs, side effects, and confusion are common barriers to adherence. Be proactive in identifying these issues and work with your patients to find affordable options or solutions to side effects.
• 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.
• Mail Order Pharmacy Program
  • Advantage MD 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.
  • PPO members: 877-293-5325
  • HMO members: 877-293-4998

Measure Exclusions

Denominator Exclusions:

• Hospice enrollment
• ESRD diagnosis or dialysis coverage dates
• Rhabdomyolysis and myopathy
• Pregnancy
• Lactation
• Fertility Medication Clomiphene
• Cirrhosis
• Pre-Diabetes
• Polycystic Ovary Syndrome

Exclusion Codes

Cirrhosis

• ICD-10-CM: K70.30, K70.31, K71.7, K74.3, K74.4, K74.5, K74.60, K74.69
  ESRD
• ICD-10-CM: I12.0, I13.11, I13.2, N18.5, N18.6, N19, Z91.15, Z99.2

Lactation

• ICD-10-CM: O91.03, O91.13, O91.23, O92.03, O92.13, O92.5, O92.70, O92.79, Z39.1

Polycystic Ovary Syndrome

• ICD-10-CM: E28.2

Pre-Diabetes

• ICD-10-CM: R73.03, R73.09

Pregnancy

• ICD-10-CM: O00-O9A, Z33.1, Z33.3, Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93 *

Rhabdomyolysis and myopathy

• ICD-10-CM: G72.0, G72.89, G72.9, M60.80, M60.819, M60.829, M60.839, M60.849, M60.859, M60.869, M60.879, M60.9, M62.82

*Please note that not all ICD-10-CM and SNOMED CT US Edition codes are listed here. For access to the complete set of codes related to Pregnancy Value Set, contact your Provider Engagement Liaison or email [email protected].