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Statin Therapy for Patients with Diabetes

According to the CDC, because heart disease is one of the most common complications of diabetes, taking statins to lower cholesterol levels can be key to preventing heart disease and stroke. People with diabetes are twice as likely to have heart disease or a stroke compared to people without diabetes, and need to understand these risks.

Measure Compliance for Medicare Part D

Members Medicare members with diabetes ages 40-75 who receive at least one fill of statin medication in the measurement year (as defined by CMS).

Note: Only pharmacy claims are used to identify and close care opportunities for this measure.

Measure Tips

  • The treatment period is defined as the earliest prescription dispensing date in the measurement year for any statin medication of at least moderate intensity through the last day of the measurement year.
  • Adherence for the SUPD measure is determined by the member remaining on their prescribed statin medication for 80% of their treatment period.

SUPD Measure Medications

Formulary statins are available for $0 copay for a 90- to 100-day supply, based on the patient’s pharmacy benefit: Atorvastatin, Lovastatin, Pravastatin, Simvastatin, Rosuvastatin

  1. Any statin prescription filled in 2023 will close the gap for the SUPD measure.
  2. Only pharmacy claims are used to close the gap.
  3. Patients must use their plan ID card for statin fills.

Measure Exclusions

Members in Hospice, End-Stage Renal Disease (ESRD), Rhabdomyolysis or Myopathy, Pregnancy/Lactation, Cirrhosis, Pre-Diabetes. Polycystic Ovary Syndrome, Fertility Medication (for example, Clomiphene).

Best Practices

Educate patients about their risk of cardiovascular disease.

Note: Statin use should always be accompanied by lifestyle modifications focused on diet and weight loss to improve a patient’s lipid panel.

Order 90-day prescriptions and enroll in-home delivery programs as a means to ensure compliance.

If there are cost concerns, consider prescribing generics, such as Atorvastatin, Lovastatin, Pravastatin, Simvastatin, and Rosuvastatin.

Consider strategies to reduce side effects while continuing statin therapy:

  • Lower the dose
  • Stop for a brief period, then re-challenge with the same or different statin

Prescribe a moderate- to high-intensity statin for patients who have both diabetes and cardiovascular disease, as it is shown to align with AHA/ACC guidelines and Statin Therapy for Patients with Cardiovascular Disease (SPC) measure specifications.

Reevaluate your patient yearly to assess the appropriateness of acceptable exclusions and recode.

HealthCare Partners (HCP) is here to help!

HCP Pharmacy Staff
Call: (516) 515–8861
Monday through Friday, 8:30am – 5:30pm EST

HCP Case Managers
Call: (888) 258–0203
Monday through Friday, 8:30am – 5:30pm EST
Our Case Managers can:

  • Teach patients about their condition.
  • Guide them in making a treatment plan.
  • Help them get medications and care.
  • Coordinate transportation based on member’s assigned benefit.
  • Set up referrals and doctor visits.
  • Provide a Nurse on call, 24/7 at (516) 238-6124.

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