PQA is Soliciting Feedback on Health Plan PDC Composite Measure

The Pharmacy Quality Alliance (PQA) has developed a new health plan performance measure focused on medication adherence, Proportion of Days Covered Composite (PDC-CMP). PQA is actively soliciting feedback on this measure via a public comment period which opened on October 3 and will close on October 24, 2022. Stakeholders are invited to provide comments  

PDC-CMP is a composite of three existing PQA health plan adherence measures:  

  1.  Proportion of Days Covered: Diabetes All-Class (PDC-DR) 
  2.  Proportion of Days Covered: Renin Angiotensin System Antagonist (PDC-RASA) 
  3. Proportion of Days Covered: Statins (PDC-STA) 

At the health plan level, PDC-CMP evaluates the composite percentage of individuals 18 years of age and older who met the Proportion of Days Covered (PDC) threshold of 80% for diabetes medications; renin angiotensin system antagonists, which are used to treat hypertension; and statins, which treat high cholesterol. Individual patients can be included in one, two or all three component measures, and PDC is calculated independently for each component measure before being combined into the composite. A higher measure rate indicates better performance.  

PDC adherence measures are used in numerous quality programs and have been associated with significant cost savings. For example, the 2021 National Impact Assessment of the Centers for Medicare & Medicaid Services (CMS) Quality Measures Report estimates that $27–$46.6 billion in health care costs were avoided for Medicare beneficiaries between 2013-18 thanks to improved patient adherence to medications for diabetes, hypertension and cholesterol. PQA’s PDC adherence measures are also used in the Health Insurance Marketplace Quality Rating System, state-level Medicaid programs and a variety of other settings. 

PDC-CMP was developed in response to stakeholder interest in a summary indicator of adherence focused on medications for the treatment of common chronic conditions. Integration of measures into a composite is a natural progression in the measurement lifecycle, and creating a PDC composite is anticipated to improve the continued usability of adherence measures in programs such as the Medicare Part D Star Ratings. In 2021, PQA membership endorsed a similar measure, Proportion of Day Covered Composite (Pharmacy) (PDC-CMP-PH), which evaluates adherence to the same classes of medications at the pharmacy level of analysis. 

As with all PQA performance measures, the development of PDC-CMP was informed and guided by panels and groups composed of experts from PQA’s membership through our systematic and transparent consensus-based process. In 2021, PQA convened a Health Plan Measure Concept Advisory Group (MCAG) that identified and prioritized the development of a composite health plan measure to capture adherence across multiple medication classes. This recommendation from the MCAG was supported by public comments received by PQA later that year 

PQA then convened a Technical Expert Panel (TEP) to refine the draft measure concept specifications. The TEP also provided input to determine the specific component PDC measures to include within the PDC-CMP measure. The health plan measure has since undergone testing with several PQA member organizations, during which the measure specifications were applied to data representative of the measure’s intended population. Testing results showed measure rates in line with expectations based on individual component rates and revealed notable opportunities for improvement in various subpopulations. Additionally, the measure was shown to be highly reliable in Medicare, Medicaid and commercial lines of business.  

PDC-CMP has received approval from PQA’s Measure Validity Panel (MVP) and Quality Metrics Expert Panel (QMEP), which recommended the measure proceed to PQA’s membership for endorsement consideration. Following a careful review of feedback received throughout the measure’s public comment period, PDC-CMP will be considered for membership endorsement at PQA’s annual all-member webinar on December 1, 2022. PQA members can find the registration link in the Member Resources Library  

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