What You Need to Know: Centers for Medicare & Medicaid Services Part D Measure — Statin Use in Persons with Diabetes

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What You Need to Know: Centers for Medicare & Medicaid Services Part D Measure — Statin Use in Persons With Diabetes

UnitedHealthcare recognizes the time and effort you put into managing the health of your patients with diabetes. To help you be as efficient as possible, we’re offering this guide with detailed information about the Statin Use in Persons With Diabetes (SUPD) Part D measure from the Centers for Medicare & Medicaid Services (CMS).

Defining the SUPD measure CMS defines this measure as the percentage of Medicare members with diabetes ages 40–75 who receive at least one fill of a statin medication in the measurement year. Members with diabetes are defined as those who have at least two fills of diabetes medications during the measurement year. Only pharmacy claims are used to identify and close care opportunities for this measure. Members who have end-stage renal disease (ESRD) and/or are in hospice care are excluded from the SUPD measure. Understanding measure rationale The SUPD measure is based on cholesterol guidelines from the American College of Cardiology/American Heart T:11” Association (ACC/AHA). The guidelines recommend moderate- to high-intensity statin therapy for patients ages 40–75 with diabetes to help prevent atherosclerotic cardiovascular disease (ASCVD).1,2 The guidelines: •• Recognize patients ages 40–75 with diabetes are at a substantially higher lifetime risk for ASCVD events and experience greater morbidity and worse survival rates following the start of clinical ASCVD. •• Indicate statins have been shown to be effective in reducing the risk for cardiovascular events. •• Align with the American Diabetes Association in recommending statin therapy for patients ages 40–75 with diabetes to help prevent ASCVD.3 Reaching the SUPD target goal To successfully meet CMS requirements, men and women who fit the measure definition must be on a statin medication for the prevention of ASCVD, if clinically appropriate. The care opportunity is addressed when a member with diabetes has at least one prescription fill for a statin or statin combination using their Part D benefit during the measurement year.

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1 Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PWF. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2013; 00:000–000. Accessed 12/11/2018. http://circ.ahajournals.org/content/circulationaha/ early/2013/11/11/01.cir.0000437738.63853.7a.full.pdf 2 Grundy, S., Stone, N., Bailey, A., Beam, C., Birtcher, K., Blumenthal, R., Braun, L., de Ferranti, S., Faiella-Tommasino, J., Forman, D., Goldberg, R., Heidenreich, P., Hlatky, M., Jones, D., Lloyd-Jones, D., Lopez-Pajares, N., Ndumele, C., Orringer, C., Peralta, C., Saseen, J., Smith, S., Sperling, L., Virani, S. and Yeboah, J. (2018). 2018 AHA/ACC/AACVPR/ AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. [online] http://www.onlinejacc.org/content/early/2018/11/02/j. jacc.2018.11.003?_ga=2.254610568.1420954589.1545174582-210462200.1544567894. Available at: http://www.onlinejacc.org/content/early/2018/11/02/j.jacc.2018.11.003?_ ga=2.254610568.1420954589.1545174582-210462200.1544567894 [Accessed 18 Dec. 2018]. 3 American Diabetes Association. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes – 2018. Diabetes Care. 2018 Jan.; 41 (Supplement 1): S86-S104. Accessed 12/11/2018; http://care.diabetesjournals.org/content/41/Supplement_1/S86

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Client Alts Internal & External Team Project Details Color Dimensions Date: 1-14-2019 9:29 AM Depot #: None Cyan, Magenta, Flat: 8.5" x 11" Creative Prod. Mgr: Shelby Mobley Name: PATH1286: Statin Use in Persons With Yellow, Black Folded: N/A Job Number: UHC201900021 Diabetes Software: CC 2018 1 Stage: IR Reading Level: None Notes: File Name: PATH1286_IR None T:8.5”

Statin Use in Persons With Diabetes

Tips and best practices for closing the care opportunity We’re grateful for the steps you take to help your patients who are UnitedHealthcare Medicare Advantage plan members avoid complications from diabetes. The following ideas can help make it easier for you to identify which members with diabetes haven’t received a statin fill this year – and next steps you can take with their treatment plan. •• Check your Patient Care Opportunity Report (PCOR) every month. Look in the Pharmacy Detail tab for members with open care opportunities. Those marked as yellow in the D14-Statin Use in Persons With Diabetes measure have had two fills of a diabetes medication, but haven’t filled a statin yet this year. •• Log in to UHCTransitionsTM (Health BI) to review members with open care opportunities. ––Under the Quality drop-down menu, select Member Rx Adherence to view your patient list. ––Members without a statin fill this year will be marked with a “Gap” under the SUPD measure. •• Consider prescribing a statin, as appropriate. If you determine a statin medication is appropriate, please send a prescription to the member’s preferred pharmacy.4 Statins shown in this table are available on a member’s UnitedHealthcare Medicare Advantage formulary.5 To close the SUPD care opportunity, a member must use their insurance card to fill one of these prescriptions in any strength/ dose by the end of the measurement year.

Formulary Statins7 Tier Tier 16 Atorvastatin Rosuvastatin Simvastatin Pravastatin Lovastatin Tier 2 Amlodipine/ Fluvastatin Atorvastatin Tier 3 Ezetimibe- Livalo®

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Contact us to learn more. For more information about how our programs can help support your patients who are UnitedHealthcare Medicare Advantage plan members, please contact your UnitedHealthcare representative. Thank you.

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4 Member may use any pharmacy in the network but may not receive preferred retail pharmacy pricing. Pharmacies in the Preferred Retail Pharmacy Network may not be available in all areas. Copays apply after deductible. 5 The formulary and pharmacy network may change at any time. 6 Lowest copay of all tier levels. 7 Medication adherence tip taken from package inserts, which were written by the medication manufacturer: Atorvastatin, rosuvastatin, pravastatin and Livalo can be taken at any time during the day. Simvastatin, lovastatin (immediate release) and fluvastatin must be taken in the evening. Please see each medication’s package inserts for specific details. All product names are registered ® trademarks of their respective holders. Use of them does not imply any affiliation with or endorsement by them.

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