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Statin Therapy for Patients with Diabetes

Advantage MD, EHP, Priority Partners, and USFHP. Members 40-75 years of age.

Percentage of members ages 40–75 during the measurement year with diabetes who do not have clinical atherosclerotic cardiovascular disease (ASCVD) who met the following criteria for the two rates.

  • Received Statin Therapy. Members who were dispensed at least one statin medication of any intensity during the measurement year.
  • Statin Adherence 80%. Members who remained on a statin medication of any intensity for at least 80% of the treatment period.

Best Practice and Measure Tips

  • The treatment period is defined as the earliest prescription dispensing date in the measurement year for any statin medication of at least moderate intensity through the last day of the measurement year. Help patients with diabetes understand they are more likely to develop heart disease or stroke, and Statins can help reduce their chance of developing these conditions.
  • Educate patients on the importance of statin medication adherence.
  • Adherence for the SPD measure is determined by the member remaining on their prescribed high or low intensity statin medication for 80% of their treatment period.
  • Adherence is determined by pharmacy claims data (the plan will capture data each time the member fills their prescription).

Measure Exclusions

Required Exclusions:

  • Palliative Care
  • Hospice
  • Fraility and Advanced Illness
  • Living in Long Term Care

Any time during the measurement year or the prior year:

  • Female members with a diagnosis of pregnancy
  • In vitro fertilization
  • Dispensed at least one prescription for clomiphene
  • ESRD or dialysis
  • Cirrhosis

During the year prior to the Measurement Year:

  • Coronary artery bypass grafting (CABG)
  • Myocardial infarction
  • Other revascularization procedure
  • Percutaneous coronary intervention (PCI)

During the Measurement Year:

  • Myalgia
  • Myositis
  • Myopathy
  • Rhabdomyolysis

During both the Measurement Year and the year prior to the Measurement Year:

  • A diagnosis of ischemic vascular disease IVD

Measure Codes

Common codes for exclusion:

  • Muscular Pain
    • G72.0 Drug Induced Myopathy
    • M62.82 Rhabdomyolysis
    • M79.1 Myalgia
  • Cirrhosis
    • K74.3 Primary biliary cirrhosis
    • K74.4 Secondary biliary cirrhosis
    • K74.69 Other cirrhosis of liver
    • K70.30 Alcoholic cirrhosis of liver without ascites
    • K70.30 Alcoholic cirrhosis of liver with ascites
  • ESRD
    • N18.6 ESRD
    • N18.5 CKD, stage 5

Measure Medications

To comply with this measure, one of the following medications must have been dispensed:

High-intensity statin therapy

  • Amlodipine-atorvastatin 40–80 mg
  • Atorvastatin 40–80 mg
  • Ezetimibe-simvastatin 80 mg
  • Rosuvastatin 20–40 mg
  • Simvastatin 80 mg

Moderate-intensity statin therapy

  • Amlodipine-atorvastatin 10–20 mg
  • Atorvastatin 10–20 mg
  • Ezetimibe-simvastatin 20–40 mg
  • Fluvastatin 40 mg bid
  • Fluvastatin XL 80 mg
  • Lovastatin 40 mg
  • Pitavastatin 2–4 mg
  • Pravastatin 40–80 mg
  • Rosuvastatin 5–10 mg
  • Simvastatin 20–40 mg

Low-intensity statin therapy

  • Ezetimibe-simvastatin 10 mg
  • Fluvastatin 20–40 mg
  • Lovastatin 20 mg
  • Pitavastatin 1 mg
  • Pravastatin 10–20 mg
  • Simvastatin 10 mg