Diabetes drug utilization review
Our reviews target two main areas.
Our focus on optimal treatment for members with diabetes and hypertension is linked to measure 3 of the Centers for Medicare & Medicaid Services (CMS) Physician Quality Reporting System. The diabetes treatment measure is also part of the Humana Physician Quality Rewards Program.
CMS recommends the use of an angiotensin-converting enzyme (ACE) inhibitor, angiotensin receptor blocker (ARB) or direct renin inhibitor for members with diabetes and hypertension.
Tier 1* and 2 ACE inhibitors/combination products
Tier 1 and 2 ARB/combination products
Direct renin inhibitors/combination products
*Tier 1 in Medicare and commercial formularies as of November 2013
To view formulary coverage for a specific drug, see Humana’s Drug List.
Humana may send faxes or mail letters to health care providers concerning optimal treatment of members with diabetes and hypertension. These communications may include the names of patients who could benefit from a change in therapy and a list of medication options. Here is a sample fax:
Health care providers may also receive information on this topic through their Humana Star Quality Report.
Our reviews show some Humana members are receiving a diabetes medication at a dose higher than the dose recommended by the U.S. Food and Drug Administration (FDA). These medications include the following categories of oral hypoglycemics: biguanides, sulfonylureas, thiazolidinediones and dipeptidyl peptidase IV inhibitors (DPP-IV).
Materials mailed to health care providers concerning this dosing include:
References used to develop our communications about diabetes treatment and medication dosing include:
Drug Facts and Comparisons© 2012 by Wolters Kluwer Health, Inc. at www.factsandcomparisons.com (accessed 8/19/2012).