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Statin Therapy for Patients with Cardiovascular Disease and Diabetes – Texas Medicaid

You can help ensure quality care for our members who have cardiovascular disease and diabetes by following guidelines on statin therapy from the National Committee for Quality Assurance. It’s important that members prescribed statin therapy adhere to their medications during their treatment period to lower cholesterol levels and reduce the risk of heart disease.

Cardiovascular disease is the leading global cause of death, according to the World Health Organization. It accounts for 17.9 million deaths per year. Statin therapy is recommended:

Statin Therapy Quality Measures

To help monitor and improve our members’ care, we track the quality measures Statin Therapy for Patients with Cardiovascular Disease (SPC) and Statin Therapy for Patients with Diabetes (SPD). You can help ensure quality care by following these guidelines from the National Committee for Quality Assurance (NCQA):

  • Men age 21-75 and women age 40-75 with clinical ASCVD should be dispensed at least one high-or moderate-intensity statin medication.
  • Adults age 40-75 with diabetes who do not have clinical ASCVD should be dispensed at least one statin medication of any intensity.
  • All patients prescribed statin therapy should remain on prescribed statin medications for at least 80% of their treatment period.

Tips to Close Gaps in Care

  • Discuss lifestyle changes with our members to lower serum cholesterol. These can include exercise, adequate sleep and good nutrition, as well as stopping smoking and substance use. We’ve created resources that may help. When diet and exercise aren’t enough, statins may be needed to achieve lower cholesterol levels and reduce the risk of heart disease.
  • Emphasize to our members the importance of staying on statin medication. Educate them on the proper dose and frequency. Consider converting their medication to a 90-day supply through mail order or a retail pharmacy to encourage adherence.
  • Discuss common side effects of statin use and what to do if our member has problems with the medication.  Remind our members to contact you if they think they are experiencing side effects. 
  • Review our member’s medication profile to confirm statin use history at follow-ups. Clearly document any diagnosis indicating an intolerance to statin therapy and any drug interactions with current medications. 

For coding tips related to statin therapy, look for this article in the BCBSTX Payer Space resources section in Availity.

References

For Texas Medicaid Provider Quality Improvement, review the following resources ranging from quality measures data to current vaccine schedules:

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX.