Statin Therapy for Patients with Cardiovascular Disease (SPC)
Line of business: BlueAlliance (Commercial) & BlueAlliance Care+ (Medicaid)
Measure Description
The percentage of males 21-75 years of age and females 40-75 years of age who were identified as having clinical atherosclerotic cardiovascular disease (ASCVD) and met the following criteria:
- Received Statin Therapy: Members who were dispensed a prescription for at least one high-intensity or moderate-intensity statin medication.
- Stating Adherence 80%: Members who remained on a high-intensity or moderate-intensity statin medication for at least 80% of the treatment period.
Definitions
- Prescription start date: the earliest dispensing date for a statin medication of at least moderate intensity during the measurement year.
- Treatment period: the prescription start date through the last day of the measurement year.
Clinical ASCVD includes:
- Myocardial Infarction (MI)
- Coronary Artery Bypass Graft (CABG)
- Percutaneous Coronary Intervention (PCI)
- Other revascularization procedures.
- At least one encounter during the measurement year and the year prior for ischemic vascular disease (IVD).
Received Statin Therapy Compliance:
- Members who had ASCVD and had at least one dispensing event for high or moderate intensity statin medication during the measurement year.
Statin Adherence 80% Compliance:
- Members who received a proportion of days covered of at least 80% during the treatment period.
Best Practices
- 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.
- Collaborate with pharmacist for monitoring adherence and patient education.
- Instruct patients to contact their practitioner if they are experiencing adverse effects.
Exclusions
Members with any of the following during the measurement year or the year prior to the measurement year:
- Pregnancy diagnosis
- In vitro fertilization
- End stage renal disease or dialysis
- Cirrhosis
- Dispensed at least one prescription for clomiphene (estrogen agonist).
Members with the following during the measurement year:
- Myalgia, myositis, myopathy, rhabdomyolysis
Other Exclusions include:
- Members in hospice during the measurement year.
- Members who received palliative care during the measurement year.
- Members who died during the measurement year.
- Members 66+ years of age with frailty and advanced illness. Members must meet BOTH the frailty and advanced illness criteria to be excluded:
- At least two indicators of frailty with different dates of service during the measurement period.
- Advanced illness with at least one of the following:
- Diagnosis of advanced illness on at least two different dates of service during the measurement year and the year prior to the measurement year.
- A dispensed dementia medication.
- Myalgia or rhabdomyolysis caused by a statin at any time in the members history through the measurement year.
High- and Moderate-Intensity Statin Medications
Description | Prescription |
High-intensity statin therapy | Atorvastatin 40-80 mg |
High-intensity statin therapy | Amlodipine-atorvastatin 40-80 mg |
High-intensity statin therapy | Rosuvastatin 20-40 mg |
High-intensity statin therapy | Simvastatin 80 mg |
High-intensity statin therapy | Ezetimibe-simvastatin 80 mg |
High-intensity statin therapy | Atorvastatin 40-80 mg |
Moderate-intensity statin therapy | Atorvastatin 10-20 mg |
Moderate-intensity statin therapy | Amlodipine-atorvastatin 10-20 mg |
Moderate-intensity statin therapy | Rosuvastatin 5-10 mg |
Moderate-intensity statin therapy | Simvastatin 20-40 mg |
Moderate-intensity statin therapy | Ezetimibe-simvastatin 20-40 mg |
Moderate-intensity statin therapy | Pravastatin 40-80 mg |
Moderate-intensity statin therapy | Lovastatin 40 mg |
Moderate-intensity statin therapy | Fluvastatin 40-80 mg |
Moderate-intensity statin therapy | Pitavastatin 1-4 mg |
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.
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