Statin Use Measures
Date: 07/15/24
Statin Use Measures
At Wellcare, we value everything you do to deliver quality care to our members – your patients. We appreciate your commitment to their positive healthcare experience.
Quality Measures
Below are two examples of Centers for Medicare & Medicaid Services (CMS) Star Ratings, which use statin therapy to evaluate health plans.
| Quality Measure | Description |
| Statin Use in Persons with Diabetes (SUPD) | Percentage of patients ages 40-75 years with at least two diabetes medicationsdispensed on unique dates of service who also received a statin medication fill during the year. |
| SUPD Exclusions* | Patients enrolled in hospice or with a diagnosis of end-stage renal disease (ESRD), rhabdomyolysis, myopathy, pregnancy, lactating, fertility, cirrhosis, pre-diabetes, and/or polycystic ovary syndrome. |
| Statin Therapy for Patients with Cardiovascular Disease | Percentage of males ages 21-75 years and females ages 40-75 years who wereidentified as having clinical atherosclerotic cardiovascular disease (ASCVD) andreceived at least one high- or moderate-intensity statin medication during the year |
| SPC Exclusions* | Members enrolled in hospice or with a diagnosis of ESRD, rhabdomyolysis,myopathy, pregnancy, in vitro fertilization, and/or cirrhosis. Also, members 66 years old as of Dec. 31 of calendar year with with two diagnosis of frailty and one diagnosis of advanced illness. |
*Not an all-inclusive list
Action
For your convenience, we have listed high- and moderate-intensity statin medications.
| High-Intensity* | Moderate-Intensity* |
| atorvastatin 40, 80 mg | lovastatin 40 mg, simvastatin 20, 40 mg, rosuvastatin 5, 10 mg |
| rosuvastatin 20, 40 mg | pravastatin 40, 80 mg, atorvastatin 10, 20 mg |
*Not an all-inclusive list
Rationale
The rationale behind these recommendations is to promote ASCVD primary and secondary prevention inhigh-risk populations, such as patients with diabetes.
American College of Cardiology (ACC)/American Heart Association (AHA) Guideline on the Management of Blood Cholesterol
| Patient Risk Category | ACC/AHA Recommendation |
| Patients 40-75 years of age with diabetes and LDL-C ≥70 mg/dL | A moderate-intensity statin |
| Patients 40-75 years of age without diabetes with LDL-C ≥70 mg/dL and ASCVD risk ≥7.5% | A moderate-intensity statin |
| Patients with severe hypercholesterolemia (LDL-C level ≥190 mg/dL) | A high intensity statin |
| Patients with established clinical ASCVD | A high intensity statin |
We recognize that you are best qualified to evaluate the potential risks versus benefits in choosing the most appropriate medications for your patients.
Reference
Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC Jr, Sperling L, Virani SS, Yeboah J. 2018 AHA/ACC/ AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018;0:1-120. DOI: 10.1161/CIR.0000000000000625