Medication Indication

Title

Medication Indication

Description

Percent of electronic prescriptions with prescriber-reported indication based on International Classification of Disease – 10

This is a reporting measure only

Rationale

Pharmacies ensure the right patient gets the right drug at the right time for the right reason. This measure will help to evaluate the right reason.

Caveats: This measure is not for performance evaluation. Pharmacists may not diagnosis patients (by entering patient-reported diagnosis in the pharmacy system). This measure will evolve over time to ensure every prescription has an indication and said indication is correct.

Logic Model

This measure is establishing the need pharmacies have for an indication on every prescription. Currently, regulatory barriers exist that prevents the measure from being ‘Every Medication Has an Indication’ however, this measure is headed in that direction.

Level of Analysis

Pharmacy (Prescription)

Data Source

Pharmacy Data

Denominator Statement

All prescriptions electronically submitted to the pharmacy during a measurement year

Denominator Calculation

1.     1. Identify all prescriptions in a pharmacy

2.    2. Identify all new prescriptions denoted as refill number 0

3.    3. Identify all new prescriptions with source field (NCPDP = electronic)

4.    4. Apply exclusion criteria

Denominator Exclusions

Any electronic prescription that was canceled by the prescriber.

Any non-human patients (e.g., cats, dogs, clinics, office-use, etc)

Denominator Exclusion Rationale

Canceled prescriptions were never filled and confirmed to not be valid prescriptions

Pharmacies may provide care to pets or other veterinarian needs, or for office-use. This patient profiles should be excluded from the measure calculation.

Numerator Statement

Percent of electronic prescriptions with prescriber reported ICD-10

Numerator Calculation

1.     Number of prescriptions with supplied ICD-10

Seguridad Measure Specification Process

Data Stratification

The measure rate will be reported as pharmacy.

If available and feasible, measure rate will be reported by type of pharmacy (e.g., health-system, community, specialty, mail-order, long-term care).

If available and feasible, measure rate will be reported by line of business (pharmacy Medicare rate, pharmacy Medicaid rate, pharmacy Commercial rate, and pharmacy uninsured rate).

Risk adjustment will be applied when available.

Value Sets

No value set is required for the calculation of this measure.

Future Iterations

Many pharmacy measures are designed as structure or process. Future goals of this concept include measures focused ensuring all prescriptions have an indication and that the indication and medication are appropriate.

Harmonization¹

Payors: N/A

Providers: This measure is similar to the CMS SNF measure ensuring all medications have an indication.