Statin Therapy for Patients with Cardiovascular Disease (SPC)
Measure Description
The percentage of members 21-75 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 at least one high-intensity or moderate-intensity statin medication during the measurement year.
- Statin 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 two diagnoses of ASCVD on different dates of service during the measurement year or the year prior to the measurement year.
Received Statin Therapy Compliance:
- Members who had at least one dispensing event for high- or moderate-intensity statin medication during the measurement year.
Statin Adherence 80% Compliance:
- Members whose proportion of days covered by at least one high- or moderate-intensity statin medication during the treatment period was at least 80%.
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 to which they can adhere (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 and document any adverse effects from statin therapy.
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 who received palliative care or hospice services during the measurement year.
- Members who died during the measurement year.
- Members 66+ years of age with frailty and advanced illness who meet BOTH the frailty and advanced illness criteria:
- 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 or 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
Statin Medication | High-Intensity Therapy | Moderate-Intensity Therapy |
Amlodipine-atorvastatin | 2.5 mg/40 mg – 10 mg/80 mg | 2.5 mg/10 mg – 10 mg/20 mg |
Atorvastatin | 40-80 mg | 10-20 mg |
Ezetimibe-Simvastatin | 10 mg/80 mg | 10 mg/20 mg – 10 mg/40 mg |
Fluvastatin | N/A | 40-80* mg |
Lovastatin | N/A | 40-60* mg |
Pitavastatin | N/A | 1-4 mg |
Pravastatin | N/A | 40-80 mg |
Rosuvastatin | 20-40 mg | 5-10 mg |
Simvastatin | 80 mg | 20-40 mg |
*extended release
Coding and Benefits Disclaimer
Providers and organizations must submit accurate and complete data in accordance with all billing, coding, and medical policy requirements. HEDIS guidance does not override official coding standards or guarantee reimbursement, as coverage is subject to applicable medical/coding policy and member-specific benefits.
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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Updated 8/28/2026
