High call volumes

Our member and provider services may be experiencing higher than normal call volumes from 12/22/25-1/9/26 due to a large number of staff being out of office.  We encourage you to utilize alternative forms of communication including secured messaging through online Member Services and Availity Essentials Provider Portal.

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Member and Provider Services Representatives will be unavailable Thursday, Jan. 1, due to the holiday. We are unable to accept walk-ins on Friday, Jan. 2., due to short staffing.


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HEDIS® Tip Sheet

Proportion of Days Covered (PDC)

Endorsed by the Pharmacy Quality Alliance (PQA)

Line of business: Marketplace

Measure Description

The percentage of members 18 years and older who met the Proportion of Days Covered (PDC) threshold of 80% during the measurement year.  A higher rate indicates better performance.

A rate is reported for each of the following:

  • Diabetes All Class
  • Statins
  • Renin Angiotensin System Antagonists

Measure Population:

  • Denominator: Members ages 18 and older as of the first day of the measurement year who were dispensed at least two prescriptions (identified in the table below) on different dates of service during the measurement year. The prescriptions can be the same or different medications.

Medications Included

Diabetes All Class:

  • Biguanides
  • Sulfonylureas
  • Thiazolidinediones
  • Dipeptidyl peptidase (DPP)-IV inhibitors
  • Meglitinides
  • Sodium glucose cotransporter 2 (SGLT2) inhibitor
  • GIP/GLP-1 Receptor Agonists
Renin-angiotensin system (RAS) antagonists:

  • Angiotensin converting enzyme (ACE) inhibitors
  • Angiotensin II receptor blockers (ARBs)
  • Direct renin inhibitor

Statins








Measure Compliance:

Patients with a medication possession ratio (MPR) or proportion of days covered (PDC) of 80% or higher, indicating adherence to their prescribed therapy.

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Best Practices

  • Include short, easy-to-understand directions with every prescription.
  • Explain why taking the medication is important and the risks of not taking the medication.
  • Educate patients on the dangers of starting and stopping medications abruptly.
  • At each visit, ask patients about their medication use, side effects, missed doses, cost issues preventing adherence, barriers to refilling prescriptions.
  • Recommend pill boxes, reminder apps, or keeping medications visible to help patients remember to take their medications.
  • Once stable, prescribe a 90-day supply and encourage the use of mail-order pharmacy.
  • Advise patients to call if they have side effects.
  • Schedule a follow-up within 30 days of starting a new prescription to check for issues and effectiveness.
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Exclusions

  • Members with end stage renal disease diagnosis
  • Members who use hospice services
  • Diabetes measure only: members with a prescription for insulin.
  • Hypertension measure only: prescription for sacubitril/valsartan

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