Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis (ART) Measure

Disease- Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis (ART) Measure

Measure Description

The percentage of members who were diagnosed with rheumatoid arthritis and who were dispensed at least one fill of a disease- modifying anti-rheumatic drug (DMARD) in the measurement year.

 This measure has a weight of one (1) Star and is part of the CMS STAR Rating System.

 Members who are diagnosed twice with rheumatoid arthritis by November 30 of the measurement year are eligible for the measure. Call to Action

 Identify your pre-compliant, non-compliant, and at-risk members using the ART Detail report available on UHC Online Provider Portal website.

 Submit replacement claims for members that were incorrectly diagnosed with rheumatoid arthritis.

 Prescribe one of the following appropriate DMARDs:

Description Prescription 5-Aminosalicylates Sulfasalazine* Alkylating agents Cyclophosphamide Aminoquinolines Hydroxychloroquine* Anti-rheumatics Auranofin, Leflunomide*, Penicillamine, Gold sodium thiomalate, Methotrexate* Immunomodulators Abatacept, Adalimumab, Anakinra, Certolizumab, Certolizumab pegol, Etaner- cept, Golimumab, Infliximab, Rituximab, Tocilizumab Immunosuppressive agents Azathioprine 50 MG*, Azathioprine 100 MG, Cyclosporine, Mycophenolate Janus kinase (JAK) inhibitor Tofacitinib Tetracyclines Minocycline

*Tier 2 medications. All other medications are Tier 3 or higher.

Measure Tips

 Ensure patients are appropriately diagnosed with rheumatoid arthritis versus osteoarthritis or other joint pain disorders.

 Prevent future erroneous submission of rheumatoid arthritis diagnosis.

 Refer members to a Rheumatologist for consultation and/or co-management of rheumatoid arthritis.

 Submit claims and encounter data in a timely manner.

 If a sample of a DMARD was provided to a patient, provide a copy of the medical record to health plan stating the physician administered DMARD’s medication to the patient during office visit.

Contact us with questions at [email protected] or speak to your Health Plan Representative. MHP00155_20180202 ARTM_20170925