Asthma Medication Ratio (AMR)
Line of business: Commercial & Medicaid
Measure Description
The percentage of members 5–64 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year.
Definitions
- Oral medication dispensing event: One prescription of an amount lasting 30 days or less. Multiple prescriptions for different medications dispensed on the same day are counted as separate dispensing events. If multiple prescriptions for the same medication are dispensed on the same day, sum the days supply and divide by 30.
- Inhaler dispensing event: All inhalers (i.e., canisters) of the same medication dispensed on the same day count as one dispensing event. Different inhaler medications dispensed on the same day are counted as different dispensing events.
- Injection dispensing event: Each injection counts as one dispensing event. Multiple dispensed injections of the same or different medications count as separate dispensing events.
- Units of medication: When identifying medication units for the numerator, count each individual medication, defined as an amount lasting 30 days or less, as one medication unit. One medication unit equals one inhaler canister, one injection, one infusion or a 30-days or less supply of an oral medication.
Notes
Members are included in the eligible population if they have had at least one of the following criteria during both the measurement year and the year prior:
- ED visit with a principal diagnosis of asthma.
- Acute inpatient encounter with a principal diagnosis of asthma.
- Four outpatient visits, telephone visits or e-visits or virtual check-ins, on different dates of service, with any diagnosis of asthma and at least two asthma medication dispensing events for any controller or reliever medication.
- Four asthma medication dispensing events for any controller or reliever medication.
- A member identified as having persistent asthma because of at least four asthma medication dispensing events, where leukotriene modifiers or antibody inhibitors were the sole asthma medication dispensed in that year, must also have at least one diagnosis of asthma, in any setting.
- Measure compliance (numerator):
Members who have a medication ratio of 0.50 or greater.
Ratio:
Units of Controller Medications
Units of Total Asthma Medications
Best Practices
- Emphasize the importance of daily use of controller medications and provide clear instructions on how to use them correctly, including proper inhaler technique.
- Once stable, prescribe a 90-day supply and encourage the use of mail-order pharmacy.
- Ensure accurate diagnosis coding, avoiding coding asthma when the condition is an asthma-like symptom (e.g., wheezing during a viral infection).
- Assist patients in identifying and eliminating asthma triggers in their home environment, such as dust mites, pets, and mold.
- Offer resources and support for smoking cessation, as tobacco smoke is a major asthma trigger.
- Educate patients on the importance of adherence to prescribed medication regimen.
- Include patient concerns/input in decision making processes for a treatment plan they can adhere to (i.e., once daily dosing, generic options, and medications to minimize side effects).
- Schedule and encourage routine follow-up and monitoring.
Exclusions
- Members who had a diagnosis that requires a different treatment approach than members with asthma (i.e., cystic fibrosis, emphysema, COPD, acute respiratory failure, chronic respiratory conditions caused by fumes or vapors, etc.).
- Members who had no asthma controller or reliever medications dispensed during the measurement year.
- Members who use hospice services.
- Members who die any time during the measurement year.
Asthma Controller Medications
Description | Prescription | Route |
Antibody inhibitors | Omalizumab | Injection |
Anti-interleukin-4 | Dupilumab | Injection |
Anti-interleukin-5 | Benralizumab | Injection |
Anti-interleukin-5 | Mepolizumab | Injection |
Anti-interleukin-5 | Reslizumab | Injection |
Inhaled steroid combinations | Budesonide-formoterol | Inhalation |
Inhaled steroid combinations | Fluticasone-salmeterol | Inhalation |
Inhaled steroid combinations | Fluticasone-vilanterol | Inhalation |
Inhaled steroid combinations | Formoterol-mometasone | Inhalation |
Inhaled corticosteroids | Beclomethasone | Inhalation |
Inhaled corticosteroids | Budesonide | Inhalation |
Inhaled corticosteroids | Ciclesonide | Inhalation |
Inhaled corticosteroids | Flunisolide | Inhalation |
Inhaled corticosteroids | Fluticasone | Inhalation |
Inhaled corticosteroids | Mometasone | Inhalation |
Leukotriene modifiers | Montelukast | Oral |
Leukotriene modifiers | Zafirlukast | Oral |
Leukotriene modifiers | Zileuton | Oral |
Methylxanthines | Theophylline | Oral |
Coding Disclaimer
The analysis of any medical coding question related to a measure is dependent on the measure’s technical specifications including the factual situations present related to the member, the practice, the professionals, and the medical services provided.
Questions
Should you have specific coding or other questions related to the measure, please send your questions to BlueAlliance@bcbsnd.com.
NCQA Copyright Notice and Disclaimer
The HEDIS® measures and specifications were developed by and are owned by NCQA. The HEDIS measures and specifications are not clinical guidelines and do not establish a standard of medical care. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures and specifications. NCQA holds a copyright in these materials and can rescind or alter these materials at any time. These materials may not be modified by anyone other than NCQA. Use of the Rules for Allowable Adjustments of HEDIS to make permitted adjustments of the materials does not constitute a modification. Any commercial use and/or internal or external reproduction, distribution and publication must be approved by NCQA and are subject to a license at the discretion of NCQA. Any use of the materials to identify records or calculate measure results, for example, requires a custom license and may necessitate certification pursuant to NCQA’s Measure Certification Program. Reprinted with permission by NCQA. © [2025] NCQA, all rights reserved.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
Updated 7/16/2025
