The percentage of individuals 18 years and older who met the Proportion of Days Covered (PDC) threshold of 80 percent for renin angiotensin system antagonists (RASA) 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 prescriptions for any RASA or RASA combination product on different dates of service in the treatment period.
' + 'Exclusions
' + 'Hospice, end-stage renal disease (ESRD), and use of sacubitril/valsartan.
' + 'Numerator
' + 'Individuals who met the PDC threshold of 80% during the measurement year.
' + 'Renin-angiotensin system antagonists (RASAs), including angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and direct renin inhibitors are commonly used in the treatment of hypertension. RASAs are also important for the chronic treatment of hypertension and proteinuria in patients with diabetes, in which these drugs have been shown to delay renal failure and heart disease.' +
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The 2017 American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines recommend ACE inhibitors and ARBs as first-line, monotherapy for the treatment of hypertension along with thiazide diuretics and dihydropyridine calcium channel blockers (CCBs).' +
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One study examined patients who previously had a myocardial infarction. Those who achieved adherence to statins, beta-blockers, and ACE inhibitors/ARBs–measured by proportion of days covered (PDC) greater than 80%–had significantly better disease-free survival.' +
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A study by Roebuck and colleagues in 2018 assessed medication adherence on health service utilization in a Medicaid population.' +
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'In 2019, Axon et al.' +
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'In 2019, Lloyd et al.' +
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'In adults with hypertension and chronic kidney disease defined as stage 3 or higher or stage 1 or 2 with albuminuria (≥300 mg/d, or ≥300mg/g albumin-to-creatinine ratio or the equivalent in the first morning void), treatment with an ACE inhibitor or an ARB is appropriate to delay kidney disease progression.' +
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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 of 80 percent for renin-angiotensin system antagonists (RASA) 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: 30 Sep 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. ACE inhibitors, ARBs) 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.
" + 'Sacubitril/valsartan is a combination product indicated for heart failure that includes sacubitril, a neprilysin inhibitor, and valsartan, an angiotensin receptor blocker. Because the focus of the PDC-RASA measure is hypertension and not heart failure, sacubitril/valsartan cannot be used to reliably capture adherence for individuals with hypertension. As a result, individuals who have one or more prescription claims for sacubitril/valsartan during the treatment period are excluded from the measure.
' + 'RASAs are taken for the long-term therapeutic benefits which include decreased risk of cardiovascular events. These therapeutic regimens may not be present or useful at the end of life or for palliative care. As a result, individuals in hospice care are excluded from the PDC-RASA measure.
' + 'In adults with hypertension and chronic kidney disease defined as stage 3 or higher or stage 1 or 2 with albuminuria (≥300 mg/d, or ≥300mg/g albumin-to-creatinine ratio or the equivalent in the first morning void), treatment with an ACE inhibitor or an ARB is appropriate to delay kidney disease progression.
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 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.
' + 'A 2014 study by Chaudhry and colleagues examined patients who previously had a myocardial infarction. Those who achieved adherence to statins, beta-blockers, and ACE inhibitors/ARBs–measured by proportion of days covered (PDC) greater than 80%–had significantly better disease-free survival.
A 2018 study by Roebuck and colleagues assessed medication adherence on health service utilization in a Medicaid population. This study found that the impact of adherence (PDC ≥80%) among Medicaid enrollees with hypertension was associated with a 15% reduction in inpatient hospitalizations, a 9% reduction in emergency department visits, and a 5% reduction in outpatient physician or clinic visits.
In 2019, Axon and colleagues analyzed the association of RASA adherence (PDC ≥80%) with healthcare utilization and expenditures among commercially-insured adults (N= 4,842,058). Adherence was associated with fewer inpatient (RR=0.612, 95% CI=0.607-0.617) and outpatient visits (RR=0.995, 95% CI=0.994, 0.997); and lower inpatient (CR=0.614, 95% CI=0.613-0.615) and total (CR=0.876, 95% CI=0.874-0.878) healthcare costs.
In 2019, Lloyd and colleagues estimated the cost of medication nonadherence (PDC <80%) among Medicare fee-for-service beneficiaries with hypertension among other chronic diseases (N=14,657,735). Medication nonadherence was calculated to be 25% for hypertension. The authors estimated the avoidable health care costs that could be saved if nonadherent beneficiaries with hypertension became adherent was $13.7 billion annually.
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.
" + "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.
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