HEDIS® Tip Sheet

Statin Therapy for Patients with Diabetes (SPD)

Measure Description

The percentage of members 40-75 years of age during the measurement year with diabetes who do not have clinical atherosclerotic cardiovascular disease (ASCVD) who met the following criteria.  Two rates are reported:

  • Received Statin Therapy: Members who were dispensed at least one statin medication during the measurement year.
  • Statin Adherence 80%: Members who remained on a statin medication for at least 80% of the treatment period.

Definitions

  • Prescription start date: the earliest dispensing date for a statin medication during the measurement year.
  • Treatment period: the prescription start date through the last day of the measurement year.  

Rate 1: Received Statin Therapy

  • Denominator:
    • Members with two diagnoses of diabetes on different dates of service during the measurement year or the year prior to the measurement year.
    • Members with one diagnosis of diabetes and dispensed insulin or hypoglycemics/ antihyperglycemics during the measurement year or the year prior to the measurement year.
  • Numerator Compliance:
    • Members with diabetes who had at least one dispensing event for high-, moderate-, or low-intensity statin medication during the measurement year.

Rate 2: Statin Adherence 80%

  • Denominator: Members who meet the criteria for Received Statin Therapy
  • Numerator Compliance:
    • Members with statin medication coverage for at least 80% of the treatment period.
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Exclusions

  • Members with any of the following during the measurement year or the year prior to the measurement year:
    • Clinical ASCVD:
      • Myocardial Infarction (MI)
      • Coronary Artery Bypass Graft (CABG)
      • Percutaneous Coronary Intervention (PCI)
      • Other revascularization procedures
      • At least two diagnoses of Atherosclerotic Cardiovascular Disease (ASCVD) on different dates of service
    • Ischemic Vascular Disease (IVD)
    • Pregnancy
    • In vitro fertilization
    • Dispensed at lease on prescription for clomiphene
    • End Stage Renal Disease (ESRD)
    • Dialysis
    • Cirrhosis
  • Members with the following during the measurement year:
    • Myalgia, myositis, myopathy, rhabdomyolysis
    • Members who received palliative care or hospice services.
    • Members who died.
  • 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 member’s history through the measurement year.
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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 pharmacists 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.

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