Product Lines:
Advantage MD Part D.

Eligible Population:
Members 18 years or older as of December 31 of the measurement year.

Definition:
Percentage of members ages 18 or older who are adherent to their diabetes medications at least 80% or more of the time they are supposed to be taking the medication in the measurement period.

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.

The higher the rate is better.

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.
  • 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.
• PPO members: 877-293-5325
• HMO members: 877-293-4998

Measure Medications

These classes of diabetes medications are included in this measure:

• Biguanides
• DPP-4 inhibitors
• Incretin mimetics
• Meglitinides
• SGLT2 inhibitors
• Sulfonylureas
• Thiazolidinediones

Measure Exclusions

Required Exclusions: Anytime in the Measurement year:

• Hospice
• End-stage renal disease (ESRD) or dialysis covered days.
• One or more prescriptions for insulin