Product Lines:
Advantage MD, Part D.

Eligible Population:
Members with diabetes ages 40–75 during the measurement year.

Definition:
Percentage of members with diabetes ages 40–75 who receive at least one fill of a statin medication in the measurement year.

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.

Best Practice and Measure Tips

• Prescribe at least one statin medication during the measurement year to patients diagnosed with diabetes.
• Medication samples, when given, could interfere with pharmacy claims and produce false non-adherence results.
• 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.

Measure Exclusions

Required Exclusions:

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

Measure Medications

This is a general medication list and should not replace the advice or care you provide your patients regarding what is optimal to meet their healthcare needs.

• Atorvastatin
• Amlodipine-atorvastatin
• Ezetimibe-simvastatin
• Fluvastatin    
• Livalo®
• Lovastatin    
• Pitavastatin    
• Pravastatin    
• Rosuvastatin    
• Simvastatin