The percentage of individuals 18 years and older who met the Proportion of Days Covered (PDC) threshold of 80 percent for any of the diabetes medications during the measurement year.
' + '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 prescription claimed ≥2 prescription claims for any of the diabetes medications on different dates of service in the treatment period.
' + 'Exclusions
' + 'Hospice, end-stage renal disease (ESRD), and use of insulin.
' + 'Numerator
' + 'Individuals who met the PDC threshold of 80% during the measurement year.
' + 'Diabetes mellitus is a chronic disease that has reached epidemic proportions in the U.S. and can lead to increased rates of heart disease, stroke and death. The UKPDS trial is the seminal research to link lowered A1c with health outcomes.' +
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Roebuck and colleagues in 2011 showed an increase in medication adherence (defined as the 80% threshold) reduced total annual health care spending primarily through decreased inpatient hospital days and emergency department visits. Regarding individuals with diabetes, adherence decreased annual medical spending by $4,413 providing a benefit-cost ratio of 6.7:1.' +
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Finally, a 2016 article by Boye and colleagues examined the association between adherence and outcomes. The results showed at higher adherence levels, all-cause acute care and outpatient costs declined. The mean outpatient and acute-care costs were $17,298 and $13,373 with a PDC ≥80% compared to $28,086 and $32,340 with a PDC <20% (P<0.005). The results were progressive based on each PDC interval (<20%; ≥20%-40%; ≥40%-60%; ≥60%-80%; ≥80%). Additionally, diabetes-related costs showed the same general trend.' +
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Individuals in hospice care are excluded from the measure because adherence to most chronic therapies does not necessarily align with the therapeutic goals and balance of risk and benefits for individuals in hospice care. In 2015, the PQA Patient & Caregiver Advisory Panel recommended that hospice should generally be an exclusion for PQA measures unless the measures are directly relevant to, and align with, the therapeutic goals for individuals in hospice care. Furthermore, the American Diabetes Association in states that appropriate diabetes management for patients in hospice may include relaxing glycemic targets and simplifying regiments, with only periodic glucose monitoring to avoid symptomatic hyperglycemia.' +
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Individuals with ESRD are excluded from the measure because adherence to diabetes medications may not be accurately reflected in pharmacy claims data due to frequent dosage and medication adjustments. Individuals with diabetes and ESRD are at higher risk for hypoglycemia than the general population. Reasons for fluctuation in blood glucose can range from drug accumulation to more complex reasons like increased glucose utilization following the correction of anemia by erythropoietin.' +
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Individuals on insulin are excluded from the measure because insulin requires titration and frequent dosage adjustments, which in turn can result in frequent dosage adjustments of other diabetes medications. Currently, there is not a standardized method to assess adherence to insulin using prescription claims data.' +
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This is a health plan performance measure that retrospectively evaluates the percentage of individuals 18 years and older who met the Proportion of Days Covered (PDC) threshold for diabetes medications during the measurement year using administrative data. This measure is not designed to be used for clinical decision making. It is intended for retrospective, population level assessment and is not intended to guide individual patient-care decisions.
' + 'Last Update: 4 Oct 2019
' + 'To qualify for the eligible population/denominator, individuals must have ≥2 prescription claims for a target medication on different dates of service. These prescription claims do not need to be for the same target medication (i.e. ' + singleAgent1 + ', ' + singleAgent2 + ') or class (i.e. biguanides, sulfonylureas) but do need to be on the target medication list.
' + 'In this example, the individual has prescription claims for target medications on 2 different dates of service. Since the prescription claims 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 prescription claims for 2 different target medications, but both are on the same date of service. Since the prescription claims need to be on different dates of service (even if for different medications), this individual would not qualify for the eligible population/denominator.
" + 'The treatment period starts with the first prescription claim for any ' + drugClass + ' medication, referred to as the 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 prescription claim for the measurement year, referred to as the 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 prescription claim 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 prescription claim for the measurement year, referred to as the index prescription start date (IPSD), is on 10/4. The individual does not qualify for the denominator since the treatment period must be at least 91 days.
" + 'Individuals with one or more prescription claims for insulin during the treatment period are excluded from the measure because insulin requires titration and frequent dosage adjustments, which in turn can result in frequent dosage adjustments of other diabetes medications. These frequent dosage adjustments may result in adherence not being accurately reflected in pharmacy claims. Currently, there is not a standardized method to assess adherence to insulin using prescription claims data.
Individuals in hospice care are excluded from the measure because adherence to most chronic therapies does not necessarily align with the therapeutic goals and balance of risk and benefits for individuals in hospice care. Furthermore, the American Diabetes Association states that appropriate diabetes management for patients in hospice may include relaxing glycemic targets and simplifying regiments, with only periodic glucose monitoring to avoid symptomatic hyperglycemia.
Individuals with ESRD are excluded from the measure because adherence to diabetes medications may not be accurately reflected in pharmacy claims data due to frequent dosage and medication adjustments. Individuals with diabetes and ESRD are at higher risk for hypoglycemia than the general population. Reasons for fluctuation in blood glucose can range from drug accumulation to more complex reasons like increased glucose utilization following the correction of anemia by erythropoietin.
The PDC calculation is appropriate for medication classes that are used on a routine basis and for which the days' supply can be accurately determined using prescription claims data. 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 through 9/24. With 365 days in the treatment period and only 278 days covered, the individual has a PDC of 76.16% which is less than the 80% threshold. Therefore, the individual should not be counted in the numerator.
' + 'Roebuck and colleagues in 2011 showed an increase in medication adherence (defined as the 80% threshold) reduced total annual health care spending primarily through decreased inpatient hospital days and emergency department visits. Regarding individuals with diabetes, adherence decreased annual medical spending by $4,413 providing a benefit-cost ratio of 6.7:1.
A 2016 article by Boye and colleagues examined the association between adherence and outcomes. The results showed at higher adherence levels, all-cause acute care and outpatient costs declined. The mean outpatient and acute-care costs were $17,298 and $13,373 with a PDC ≥80% compared to $28,086 and $32,340 with a PDC <20% (P<0.005). The results were progressive based on each PDC interval (<20%; ≥20%-40%; ≥40%-60%; ≥60%-80%; ≥80%). Additionally, diabetes-related costs showed the same general trend.
Yes. To calculate the PDC as a percentage, divide the number of covered days by the number of days and multiply by 100. The PDC should then be rounded to the nearest hundredth (e.g. 79.996% is rounded to 80.00%, 79.992% is rounded to 79.99%) before comparing to the threshold of 80%.
" + "If multiple prescription claims 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 prescription claim start date to be the day after the days' supply for previous prescription claim has ended. This is based on the assumption that patients will finish medication from the existing fill before beginning to take medication from the new fill.
" + "For this example, the individual's prescription claim on 3/25 overlaps with the days' supply for the prescription claim on 1/1. Because the prescription claims on 1/1 and 3/25 involve the same target drug, the start date for the prescription claim on 3/25 is adjusted to be the day after the days' supply for the prescription claim on 1/1 has ended. The same would apply for the prescription claim on 9/25 that overlaps with the days' supply for the prescription claim on 7/5.
" + 'For this example, the individual's prescription claim on 3/25 overlaps with the days' supply for the prescription claim on 1/1. However, because the prescription claims on 1/1 and 3/25 do not involve the same target drug, the start date for the prescription claim 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 prescription claim start date to be the day after the days' supply for previous prescription claim has ended.
" + "For this example, the individual's prescription claim on 3/25 overlaps with the days' supply for the prescription claim on 1/1. Because the prescription claim for the single ingredient product on 1/1 and the prescription claim for the combination product on 3/25 both include the same target drug, the start date for the prescription claim on 3/25 is adjusted to be the day after the days' supply for the prescription claim on 1/1 has ended.
" + 'These measures use administrative claims data, which do not contain the data elements needed 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 prescription claim has ended.
" + "For the 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.
" + '