Mount Carmel Health Partners HEDIS Tip Sheets | Page 24

HEDIS Tip Sheet
• If patient meets any of the exclusion criteria, please note for future reference.
Member Outreach Tips:
• Encourage patients to schedule an appointment with their PCP if they have not had a preventive visit during the
measurement year.
• If the medical record indicates that the patient is on a DMARD and a prescription has not been filled, consider
the following options: Has the patient not filled the prescription this year? Is the patient not filling the
prescription through his or her insurance? Has the patient stopped taking the medication, and if so, why? Is the
patient using discount cards/coupons which might prevent the prescription being run through insurance? Is the
patient using copay assistance through the drug company?
Supplemental Data Tips
This measure must be met through either pharmacy data or claims, meaning supplemental data cannot be used.
Below is a list of DMARDs
Description
Prescription
5-Aminosalicylates  Sulfasalazine (Azulfidine)
Alkylating agents  Cyclophosphamide (Cytoxan, Cytoxan Lypholized)
Aminoquinolines  Hydroxychloroquine (Plaquenil)
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 Auranofin (Ridaura)
 Methotrexate (Trexall, Rasuvo, Otrexup, Rheumatrex Dose Pack, Xatmep)
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 Abatacept (Orencia)
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 Certolizumab (Cimzia)
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 Infliximab (Inflectra, Remicade)
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 Azathioprine (Imuran)
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 Mycophenolate mofetil (CellCept)
Janus kinase (JAK) inhibitor  Tofacitinib (Xeljanz)
Tetracyclines  Minocycline (Minocin, Vectrin, Solodyn)
Anti-rheumatics
Immunomodulators
Immunosuppressive agents
Penicillamine (Cuprimine, Depen)
Leflunomide (Arava)
Anakinra (Kineret)
Adalimumab (Humira)
Etanercept (Enbrel)
Golimumab (Simponi)
Rituximab (Rituxan)
Tocilizumab (Actemra)
Cyclosporine (Sandimmune, Gengraf, Neoral)
Mycophenolic Acid (Myfortic)
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