Mount Carmel Health Partners HEDIS Tip Sheets | Page 27

HEDIS Tip Sheet
Medication Adherence for Diabetes
Definition: Percentage of Part D beneficiaries, ages 18 and older, who fill their diabetes medication enough to cover
80% or more of the time they are taking the medication.
Service Needed: Filling prescriptions for diabetes medications.
Exclusions: Hospice care in the measurement year.
Chart Review Tips:
• Diabetes medications are defined as: biguanide drugs, sulfonylurea drugs, thiazolidinedione drug, a DPP-IV
inhibitor, an incretin mimetic drug, or a meglitinide drug. Insulin is not included.
• Diabetes medications can be found in the “Medications” section of the chart or noted in the recent office
visit/progress note.
Member Outreach Tips:
• Ask patients if they are taking (or have been prescribed) a medication for diabetes.
• Encourage patients to take medications as prescribed. If patients do not take medication as prescribed, ask why:
Lack of funds? A problem with side effects?
Supplemental Data Tips
• This measure must be met through either pharmacy data or claims, meaning supplemental data cannot be used.
• Patients may be taking medication as prescribed and not using their insurance benefits (for example: $4
prescriptions), which would cause them to appear not meet the metric falsely.
Biguanides include: Incretin mimetics include:
Glucophage (metformin) Bydureon, Byetta (exenatide)
Victoza (liraglutide)
Thiazolidinediones include: Meglitinides include:
Avandia (rosiglitazone) Starlix (nateglinide)
Actos (pioglitazone) Prandin (repaglinide)
Sulfonylureas include: DPP-IVs include:
Diabinese (chlorpropamide) Januvia (sitagliptin)
Glucotrol and Glucotrol XL (glipizide) Onglyza (saxagliptin)
Micronase, Glynase, and Diabeta (glyburide) Tradjenta (linagliptin)
Amarly (glimepiride) Nesina (alogliptin)
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