“Statin Use in Persons with Diabetes” is a Medicare Star Ratings quality measure. According to the American Diabetes Association guidelines, statins should be considered for all patients with diabetes ages 40-75 to reduce the risk of cardiovascular events and death, regardless of their LDL level*. If you have a Medicare member who qualifies, but is not an appropriate candidate for a statin, we need you to submit a claim with the appropriate ICD-10 Code to exclude the patient from the quality measure. For details, see Statin Use in Persons with Diabetes.
If you need assistance finding clinically appropriate medications for your members, call our clinical pharmacist at 718-938-2174.
*Centers for Medicare & Medicaid Services. Part C&D Performance Data. Page 109. Last Modified 02/05/2024. https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovgenin/performancedata