A pharmacy quality measure has been introduced as a CMS Star Ratings display measure for 2018 and is anticipated to become a full measure in 2019.

What are display measures?

Display measures are not part of the Star Ratings. They include measures that have been transitioned from the Star Ratings, new measures that are tested before inclusion into the Star Ratings, or measures displayed for informational purposes.

Why is CMS targeting statin use in diabetes?

According to the American Diabetes Association (ADA), diabetes costs us $176 billion per year in direct medical fees. Put another way, more than 1 in 10 healthcare dollars are spent on diabetes and its complications, and more than 1 in 5 healthcare dollars go to treating people with diagnosed diabetes. It’s a disease that affects more than 25 million Americans and is the seventh leading cause of death in the U.S. The American Heart Association (AHA) reports that diabetes is a major controllable risk factor of arteriosclerotic cardiovascular disease (ASCVD). Patients with diabetes are two to four times more likely to develop heart disease and stroke. In fact, heart disease and stroke are the leading cause of disability and death in diabetic patients.^1-5

Measure Description

1. Identify potential gaps in therapy—no statin.

• Participate in medication therapy management programs that include targeted interventions that help identify gaps in care. These types of programs can help identify patients for you.
• Review for patients with diabetes who are on an oral diabetes agent, check to ensure they are also on a statin.
• Review the patient profile or ask open-ended questions to determine if a potential gap in therapy exists when counseling diabetic patients.
• Leverage technicians and the whole pharmacy team to refer patients with diabetes to the pharmacist for counseling in order to identify potential gaps in therapy.

2. Discuss with patients if a gap is identified.

• Ask open-ended questions to find out what the patient might have tried in the past or may know about these types of medications. Djscuss the benefits of using statin medications to reduce the risk of heart disease.
• Offer to call or fax the prescriber to request a new prescription.

3. Contact the prescriber let s/he know about the potential gap in therapy identified, as well as any pertinent information from the discussion with the patient.

• Use physician fax templates (such as the sample in Appendix C) and customize as needed.

NOTE: This recommendation is supported by the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. Use evidence-based information as needed to inform your discussions.

REFERENCES
1. Stone NJ, Robinson J, Lichtenstein AH, et al. 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. Accessed April 25, 2015.
2. American Diabetes Association. The Cost of Diabetes. Accessed April 25, 2015
3. U.S. Department of Health and Human Services National Diabetes Education Program. The Facts About Diabetes. Accessed April 25, 2015.
4. Centers for Disease Control and Prevention. Leading Causes of Death. Accessed April 25, 2015.
5. American Diabetes Association. Statistics About Diabetes. Accessed April 25, 2015.