PQA Endorses Two New Diabetes-Focused Health Plan Performance Measures

Alexandria, Va. (December 21, 2020) – The Pharmacy Quality Alliance (PQA), through a majority vote of its members, has endorsed two new health plan performance measures. The measures evaluate medications to treat individuals with diabetes. More than 34 million Americans have diabetes, according to the Centers for Disease Control and Prevention. These measures will help evaluate the quality of care for a disease that annually costs America $327 billion.

The first measure, Use of Medications to Prevent Major Cardiovascular Events in Persons with Diabetes (CVDM), evaluates the percentage of individuals 18 years and older who have type 2 diabetes and established atherosclerotic cardiovascular disease that are prescribed a GLP-1 receptor agonist or SGLT-2 inhibitor with proven cardiovascular benefit during the measurement year.

This clinical guideline-based measure is aligned with the American Diabetes Association Standards for Medical Care and the European Association for the Study of Diabetes recommendations to include these important medications as part of the treatment regimen. 

The second measure, Persistence to Basal Insulin (PST INS), evaluates the percentage of individuals 18 years and older who were treatment persistent to basal insulin during the measurement year. Unlike medication adherence, persistence is the time from initiation to discontinuation of therapy and does not rely on the prescribed days’ supply for calculation.   

Basal insulin, also known as background insulin, is a longer-acting type of insulin that helps keep blood sugar levels steady day and night. Studies have demonstrated that persistence to basal insulin is associated with improved outcomes, including lower healthcare utilization, fewer hospitalizations, and decreased hemoglobin A1c level. Despite recommendations for treatment with basal insulin for those that fail to meet glycemic targets, insulin continues to be underutilized.

“With approximately 10% of the U.S. population having diabetes, we are pleased to add these measures to our portfolio, providing additional tools for health plans to identify opportunities for medication therapy with proven cardiovascular benefit,” said Lisa Hines, PharmD, PQA Vice President, Performance Measurement. “Additionally, Persistence to Basal Insulin is a unique measure that fills an important diabetes medication quality measurement gap.”

PQA collaborated with several of its health plan and pharmacy benefit management member organizations to test the measures, a key step in the measure development process. Working with multiple testing partners allows PQA to evaluate how measures perform across different health plans, understand variation in performance and room for improvement and assess the measure’s scientific acceptability. 


Contact: Richard Schmitz, PQA Senior Director of Communications, [email protected] or 703-347-7931

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