Close gaps in Statin Use in Persons with Diabetes measure

The Centers for Medicare & Medicaid Services defines the Statin Use in Persons with Diabetes, or SUPD, Medicare Star measure as the percent of Medicare Part D patients between 40 and 75 years old who received at least two diabetes medication fills, and who also received a statin medication fill during the calendar year. Guidelines from the American Diabetes Association, American College of Cardiology and the American Heart Association support the use of statins in patients with diabetes for cardiovascular risk reduction, regardless of LDL cholesterol levels.

How to close a gap in the SUPD measure

The patient must have a paid claim for a statin through the Part D benefit, or the health care provider must bill an eligible ICD-10 diagnosis code to remove the patient from the measure if a statin isn’t appropriate. A claim or code must occur every year the patient is in the measure for the gap to be closed. Additionally, only certain diagnosis codes will close a gap, such as those for myopathy, myositis, pre-diabetes and abnormal blood glucose, for example. A list of eligible ICD-10 codes can be found on this tip sheet.

If the patient doesn’t have an upcoming appointment in the calendar year, providers may also call the patient to confirm the ICD-10 diagnosis code, document it in the medical record and then bill the non-reimbursable HCPCS code G9781 for $0.01 with the applicable ICD-10 code attached to process the claim and remove the patient from the Star measure.

Note: Only statin claims billed through the patient’s Part D plan count toward closing gaps in the measure.

The following types of statin claims will not close a gap in the SUPD measure:

• Claims filled through Good Rx or pharmacy discount programs (for example, Kroger Health Savings Club, Amazon RxPass)
• Cash claims
• Medication samples
• Fills from Veterans Affairs facilities
• Fills billed to a non-Medicare insurance plan