PQA Diabetes Cluster Group

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PQA Diabetes Cluster Group

• Pharmacy Quality Alliance
• Quality Measures for Diabetes

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Medication Overuse Dosing

• Description
• Patients receiving oral hypoglycemic agents
  exceeding FDA-approved labeling
• Population taking OHAs at monthly intervals
  during measurement period
• Definitions
• Oral hypoglycemic agents
• Higher than recommended dose
• Rationale
• Minimize the likelihood of hypoglycemic episodes
  and dose related adverse drug events directly
  related to the prescribed overuse of appropriate
  diabetes therapies.
• Denominator Description
• Number of adults with at least one claim for an
  oral hypoglycemic agent who were continuously
  enrolled in a drug plan during the six-month
  observation period.
• Numerator Description
• Number of patients in the denominator who are on
  higher than recommended doses
• Data Source
• Pharmacy claims data

3
Medication Overuse Duplication of Therapy

• Description
• Patients on oral hypoglycemic agents that have
  a duplication of therapy
• Population taking OHAs at monthly intervals
  during the measurement period
• Definitions
• Therapeutic class As described by mechanism of
  action in the FDA-approved label
• Duplication of therapy Concomitant dispensing
  of two agents in same therapeutic class
• Rationale
• Minimize the likelihood of hypoglycemic events
  directly related to medication overuse attributed
  to two different agents with similar
  pharmacological activity.
• Denominator Description
• Number of adults with at least one claim for an
  oral hypoglycemic agent who were continuously
  enrolled in a drug plan during the six-month
  observation period.
• Numerator Description
• Number of patients in the denominator who are on
  two or more medications in same therapeutic class
• Data Source
• Pharmacy claims data

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Medication UnderuseSuboptimal Treatment Regimen

• Description
• Patients with a pharmacy claim for an oral
  hypoglycemic medication or insulin with a
  concurrent claim for an antihypertensive agent
  but no claim for an ACEI or ARB.
• Definitions
• Oral hypoglycemic agent
• Antihypertensive agent
• Rationale
• Proactively treat a secondary complication of
  diabetes, nephropathy. Micro/macro albumin test
  results are not accessible via pharmacy claims
  data and therefore difficult to glean which
  patients are in need of renal protection. The
  co-morbid condition of hypertension (as
  determined by pharmacy claims) will be the
  trigger for this measure.
• Denominator Description
• Number of adults with at least one claim for an
  oral hypoglycemic agent or insulin and at least
  one claim for an antihypertensive agent who were
  continuously enrolled in a drug plan during the
  six-month observation period.
• Numerator Description
• Number of patients in the denominator without an
  ACE or ARB claim
• Data Source
• Pharmacy claims data

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Feedback Received On Proposed Metrics

• Medication Under-use dose too low
• Premise of the metric is reasonable and
  consistent with other metrics
• Confounding variable make this metric more
  complex to systematically glean quality
• Examples include titration schedules, cross over
  therapies, geriatric dosing, hepatic/renal
  considerations, sensitivity
• Insulin metrics
• There are no proposed measures reviewing insulin
  medication management
• Patient care strategies vary greatly on this
  issue
• Lack of consensus on what could be measured
• Lack of scientific evidence on value of pharmacy
  claims data alone
• Question to the value of Medication Overuse
  dose too high
• Feedback Doesnt the PBM put a hard edit on
  this metric?
• Our diligence on this issue tells us there may be
  edits, but they can overridden and therefore
  opportunities to measure performance