The percentage of patients 18 years and older who met the Proportion of Days Covered (PDC) threshold of 80 percent during the measurement period for direct-acting oral anticoagulants.
' + 'A higher rate indicates better performance.
' + 'Intended Use
' + 'Performance measurement for health plans.
' + 'Data Sources
' + 'Prescription claims data.
' + 'Denominator
' + 'Individuals 18 years and older who filled at least two prescriptions for a direct-acting oral anticoagulant on 2 unique dates of service at least 180 days apart during the treatment period AND who received greater than 60 days supply of the medication during the treatment period.
' + 'Exclusions
' + 'Individuals using warfarin, low molecular weight heparin, heparin, and/or SC Factor Xa inhibitors.
' + 'Numerator
' + 'Individuals who met the PDC threshold of 80% during the measurement year.
' + 'Adherence to all anticoagulants is important. Warfarin was not included in this adherence measure due to frequent dosing adjustments to therapy, making the PDC calculation, which is based on prescription claims, less reliable. Adherence to non-warfarin anticoagulants may be more critical to monitor since there isn't a surrogate lab value such as INR.
" + 'To qualify for the eligible population/denominator, individuals must have ≥2 fills for a target medication on different dates of service at least 180 days apart during the treatment period. These fills do not need to be for the same target medication (i.e. ' + singleAgent1 + ', ' + singleAgent2 + ') but do need to be on the target medication list.
' + 'In this example, the individual has fills for target medications on 2 different dates of service. Since the fills do not need to be for the same target medication, this individual would qualify for the eligible population/denominator.
' + 'In this example, the individual has fills for 2 different target medications but are on the same date of service. Since the fills need to be on different dates of service (even if for different medications), this individual would not qualify for the eligible population/denominator.
" + 'Sum the days' supply across all claims for target medications during the treatment period. There is no need to truncate any days' supply that extends beyond the end of the measurement year.
" + "The treatment period starts with the first fill for any ' + drugClass + ' medication, or index prescription start date (IPSD), and ends with the last day of the measurement year, death, or disenrollment, whichever occurs first. The treatment period must be at least 91 days long for the individual to be included in the measure denominator.
' + "For this example, the individuals's first fill for the measurement year, or index prescription start date (IPSD), is on 3/25. The treatment period for the individual is only 282 days since the treatment period starts with the IPSD.
" + 'For this example, the individual's days' supply for the fill on 10/15 extends beyond the end of the measurement year. The days' supply beyond the end of the measurement year does not count toward the days in the treatment period or the days covered.
" + 'For this example, the individual's first fill for the measurement year, or index prescription start date (IPSD), is on 10/4. The individual does not qualify for the denominator since the treatment period should be at least 91 days.
" + 'No. Individuals who have one or more fills for warfarin, low molecular weight heparin, heparin, and/or SC Factor Xa inhibitors during the treatment period are excluded from the measure.
' + 'Individuals with ESRD have been excluded from these measures because adherence to diabetes, hypertension, and statin medications may not be accurately reflected in pharmacy claims data due to frequent dosage and medication adjustments. There is a lack of direct evidence that these treatments are beneficial in dialysis patients. Selected references are listed below:
' + 'The PDC calculation is appropriate for medication classes that are used on a routine basis and in which the days' supply can be accurately determined. For these reasons, our PDC measures are limited to medication classes used for chronic conditions (e.g., diabetes, hypertension, hypercholesterolemia) requiring on-going treatment and taken on a scheduled basis where days' supply and refills can be used to estimate medication use.
" + "Individuals with a proportion of days covered (PDC) of 80% or greater qualify for the numerator.
' + 'For this example, the individual is without medication from 6/30 thru 9/24. With 365 days in the treatment period and only 278 days covered, the individual has a PDC of 76% which is less than the 80% threshold. Therefore, the individual should not be counted in the numerator.
' + 'Below is a list of the key studies that we have found in support of the 80% PDC threshold. The article from Sokol looks at medical costs, drug costs, and hospitalization risk at various levels of adherence.
' + "If multiple fills for the same target medication (i.e. one or more products with the same generic ingredient) are dispensed on the same day or different days where the days' supply overlap, adjust the fill start date to be the day after the days' supply for previous fill has ended.
" + "For this example, the individual's fill on 3/25 overlaps with the days' supply for the fill on 1/1. Because the fills on 1/1 and 3/25 involve the same target drug, the start date for the fill on 3/25 is adjusted to be the day after the days' supply for the fill on 1/1 has ended. The same would apply for the fill on 9/25 that overlaps with the days' supply for the fill on 7/5.
" + 'For this example, the individual's fill on 3/25 overlaps with the days' supply for the fill on 1/1. However, because the fills on 1/1 and 3/25 do not involve the same target drug, the start date for the fill on 3/25 is not adjusted.
" + 'When there is overlap of a single agent and a combination product containing the same target drug (same generic ingredient) or when there is overlap of a combination product and another combination product with at least one of the target drugs (same generic ingredient) in common, adjust the fill start date to be the day after the days' supply for previous fill has ended.
" + "For this example, the individual's fill on 3/25 overlaps with the days' supply for the fill on 1/1. Because the fill for the single ingredient product on 1/1 and the fill for the combination product on 3/25 both include the same target drug, the start date for the fill on 3/25 is adjusted to be the day after the days' supply for the fill on 1/1 has ended.
" + 'These measures use administrative claims data so are unable to account for discontinuation of a medication. Even so, this should not disproportionately impact certain health plans.
" + "When calculating the PDC, individuals only need to be covered by one target medication for each day in the treatment period. The PDC calculation allows for switching between target medications (i.e. " + singleAgent1 + ", " + singleAgent2 + ") during the treatment period. The treatment period does not end for discontinuation of a medication. However, for overlapping prescriptions involving the same target medication (or single agent and combination products containing the same target medication), we adjust the prescription start date to be the day after the previous fill has ended.
" + "For the Proportion of Days Covered: Diabetes All-Class Rate (PDC-DR) measure, individuals only need to be covered by one medication for each day in the treatment period. It does not need to be the same target medication (i.e. " + singleAgent1 + ", " + singleAgent2 + ") or class (i.e. biguanides, sulfonylureas) but does need to be on the target medication list.
" + "For this example, the individual is covered by several different medications during the treatment period. However, the individual is not covered by any single medication throughout the treatment period.
" + '