diabetes

Diabetes drug utilization review

Our reviews target two main areas.

Statin use in persons with diabetes

Statin use in persons with diabetes” (SUPD) was endorsed by the Pharmacy Quality Alliance (PQA) as a new performance measure in 2014 and adopted as a Centers for Medicare & Medicaid Services display measure in 2015. The SUPD measure represents the percentage of Medicare Part D beneficiaries 40-75 years old who were dispensed at least two diabetes medication fills and received a statin medication fill.

The measure is based on 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, which recommend moderate- to high-intensity statin therapy for primary prevention of atherosclerotic cardiovascular disease (ASCVD) events for persons aged 40 to 75 years with diabetes.

Statin medications

The ACC/AHA 2013 Guidelines recommend the below appropriate statins based on their intensity to achieve relative reductions in LDL cholesterol.

High-intensity statin therapy Daily dose lowers LDL-C on average by 50 percent or more Moderate-intensity statin therapy Daily dose lowers LDL-C on average by 30 to 50 percent Low-intensity statin therapy Daily dose lowers LDL–C on average by less than 30 percent

atorvastatin (40†) – 80 mg

rosuvastatin 20 (40) mg

atorvastatin 10 (20) mg

rosuvastatin (5) 10 mg

simvastatin 20 – 40 mg‡

pravastatin 40 (80) mg

lovastatin 40 mg

fluvastatin XL 80 mg

fluvastatin 40 mg bid

pitavastatin 2 – 4 mg

simvastatin 10 mg

pravastatin 10 – 20 mg

lovastatin 20 mg

fluvastatin 20 – 40 mg

pitavastatin 1 mg

†Evidence from one randomized controlled trial only: down-titration if unable to tolerate atorvastatin 80 mg in incremental decrease through aggressive lipid-lowering study (IDEAL).

‡Although simvastatin 80 mg was evaluated in randomized controlled trials, initiation of simvastatin 80 mg or titration to 80 mg is not recommended by the FDA due to the increased risk of myopathy, including rhabdomyolysis.

  • Tier 1: lovastatin 10 mg and 20 mg*
  • Tier 2: lovastatin 40 mg*, pravastatin*, simvastatin*, atorvastatin**
  • Tier 3: Crestor** Current information is available at Humana.com/druglistsearch.
  • *Moderate-potency statin
  • **High-potency statin
  • Tiers 1 through 3 are based on 2017 plan 17216 Walmart Basic PDP.

To view formulary coverage for a specific drug, see Humana’s drug lists.

Humana may send faxes or mail letters to health care providers concerning treatment of patients with diabetes. These communications may include the names of patients who may benefit from a change in therapy and a list of medication options. Here is a sample fax:

Sample statins use in people with diabetes fax(link opens in new window) 

Health care providers also may receive information on this topic in their Humana Star Quality Report.

Diabetes medication dosing

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, dipeptidyl peptidase-IV inhibitors (DPP-IV) and sodium-glucose cotransporter inhibitors (SGLT-2).

Health care providers may receive mailings concerning these dosing recommendations:

References

References used to develop our communications about diabetes treatment with lipid-lowering medications and medication dosing include:

  1. Stone, Neil J., et al. "2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults." Journal of the American College of Cardiology (2013).
  2. Drug Facts and Comparisons© 2015 by Wolters Kluwer Health Inc. at www.factsandcomparisons.com (accessed June 15, 2015).