January 2017
Volume: 6  Issue: 1 
Visit our website at www.nepho.org
for more information, including: calendars, health plan information, fee schedules and more
In This Issue
AQC Quality: New Statin Medication Adherence Measure 
Starting January 2017, patients with diabetes who are prescribed a statin will be measured for adherence to statin medication prescriptions.  The percentage of patients with proportion of days covered (PDC) with statin medication > 80% of the time will be considered adherent. The MINIMUM threshold percentage for patients meeting this target (>80%) is 69%. In 2016, when this measure was reporting only, NEPHO reached only 65%.

In 2016, 40% of all patients with diabetes met the criteria for inclusion in this measure. Criteria noted below will exclude BCBS members with diabetes from this measure, resulting in a small denominator of members to manage:
  • Members in hospice
  • Members identified with cardiovascular disease (e.g. myocardial infarction, atherosclerotic heart disease, etc.)
  • Pregnancy, IVF
  • End Stage Renal Disease (ESRD)
  • Cirrhosis
  • Members with myalgia, myositis, myopathy, or rhabdomyolysis from statins during the measurement period 
It is important to code patients who develop myalgias, etc. from statins with the appropriate coding during the current measurement year (2017).  
 
ICD 10 Code
Description
M79.1
Myalgia
M79.1
Myalgia and myositis
G72.0
Drug-induced myopathy
G72.2
Myopathy due to other toxic agents; Steroid induced myopathy
G72.9
Myopathy, unspecified; Myopathic disease; Muscle paresis
M62.82
Rhabdomyolysis; Rhabdomyolysis due to statin therapy
 
 







Keys for Success:
  • Explain the cardiovascular benefits and potential side effects of statin therapy
    • re-challenge with different statin or dosing schedule if side effects occur
  • Timely follow-up to ensure that cholesterol lowering goals are being met
  • 90-day prescriptions (once patient is tolerating a stable dose)
  • Scripts for splitting tabs OR dosing 1 - 2 tabs weekly should be written as such
  • Encourage use of mail-order and/or automatic refills
  • Muscle pain or weaknesses are the most common reasons for statin discontinuation. CODING FOR THESE CONDITIONS IN 2017 WILL EXCLUDE PATIENTS FROM THIS MEASURE
  • Recommend Medication Adherence Tools when appropriate:
Next Steps:
  • Provider to code for myopathy, etc. when identified; providers will be given names of patients with opportunities to re-code when appropriate
  • PHO Pop Health Pharmacy Tech to outreach pharmacy, patient to determine adherence issues; offer phone app and/or adherence tools
  • Pop Health NP to follow statin utilization / adherence for A1C managed patients

High Drug Costs and Decreased Medication Adherence 

It's a new year and patients are being challenged with increased costs for their medications and co-pays as a result of health plan changes and increased deductibles.

Here are some key points to help you and patients understand some of these changes:
  • Many commercial and Medicare Part D Plans have had an increase in prescription plan deductibles beginning in January 2017.  (e.g. Most Medicare Part D Plans require the patient to pay initially $400 out of pocket, BEFORE co-pay coverage begins.  The total cost of the medication contributes to the deductible until $400 is reached)
  • If a patient sees a big increase in cost of medication OR the medication is no longer covered, patient should contact health plan to find out the new "preferred" medication.  (e.g. Spiriva has been replaced with Incruse Ellipta for some plans)
  • Many generic medications such as nadolol and doxycycline have had a big increases in cost over the last year.
  • To understand the cost of prescriptions and the complicated pathway for drugs from factory to the patient, see the drug pipeline to profit pathway.  It shows middlemen in the pathway, how each makes money and the final cost to the patient.
  • Increased cost of medications may result in lower medication adherence rates.  It is important to assess medication adherence when discussing costs with patients. Some questions to ask patients:  "In the last 2 weeks, have you missed any doses of your inhaler / blood pressure medication?" OR "How do you organize or manage your medications?"
    •  BCBS data from May - Oct 2016 shows medication possession ratios (MPR), a measurement of prescription fill adherence of > 80% of the time, for several therapeutic classes that have poor medication adherence rates:
                
      Therapeutic Class
      % of Patients with MPR < 80%
      Oral Antidiabetics
      30%
      Antihyperlipidemics
      23%
      Antihypertensives
      24%
      Antidepressants
      30%
      Steroid Inhalers
      62%
      All Class Average
      35%
Schedule II Opioid Partial Fill Requirements
As of March 14, 2017 a change in MA State law will allow patients the option of requesting less than the prescribed amount of Schedule II Opioids. Prescribers must  include a notation on the prescription indicating a lesser amount is permitted if requested by the patient.  The following abbreviated statement will suffice:  "Partial fill upon patient request".
  • This notation may be in writing or electronically printed.
  • A pharmacist cannot dispense a Schedule II (in whole or in part) based on a prescription lacking this required verbiage.  A pharmacist must call the prescriber's office to notify if reduction in amount dispensed.  The balance of the quantity dispensed is voided.
By January 1, 2018, prescribers must insure EMR software or prescription forms for Schedule II opioids include the required notation.
Any questions can be directed to dcp.dph@state.ma.us or call 617-624-6000.
 
NEPHO Clinical Newsletter
Produced by Northeast Physician Hospital Organization
For more information contact: 
 
Carol Freedman, RPh, MAS, BCGP 
Clinical Pharmacist NEPHO 
978-236-1774
Cfreed@nhs-healthlink.org  
Louis Di Lillo M.D., Northeast PHO Medical Director 

Copyright © 2016. All Rights Reserved.