SUPD - Statin Use in Persons with Diabetes

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.
  • 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 is depended on pharmacy claims.
    • Encourage member to obtain 90 days supplies at their pharmacy. 
    • Consider adding directives to prescriptions instructing the pharmacy to run it through the patient’s pharmacy benefit. 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.
  • 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

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