PCP HEDIS Documentation Tips: Older Adults

Transcription

1 Women years of age with one or more mammograms within the last 2 years. PCP HEDIS Documentation Tips: Older Adults HEDIS Measure Definitions What You Can Do Coding/Tips BCS - Breast Cancer Screening Educate women regarding the benefit of early detection of breast cancer through routine mammograms MRP - Medication Reconciliation Post Discharge The percentage of discharges during the year for member 18 and older for whom medications were reconciled the date of discharge through 30 days after discharge (31 total days) COA Care for Older Adults The percentage of adults 66 years and older who had each of the following during the measurement year: Advance Care Planning Medication Review Functional Status Assessment Pain Assessment Encourage mammography to all women who are within measure age group. Submit the appropriate mastectomy code to exclude women from this measure if it is part of their history Document in the medical record must include evidence of medication reconciliation of current and discharge meds and the date it was performed by a prescribing practitioner, clinical pharmacist or RN. Regular medication review is a best practice. Have members bring all of their medications with them to appointments. Advance Care Planning - document discussion and/or presence of advance directive or living will in the chart Medication Review - Medication list in chart with a dated notation of meditation review annually by a prescribing provider or clinical pharmacist Functional Status Assessment - Complete functional assessment must include one of the following: - Notation that Activities of Daily Living (ADL) were assessed *or at least five of the following were assessed: bathing, dressing, eating, transferring, using toilet, walking+ - Notation that Instrumental Activities of Daily Living (IADL) were assessed *or at least four of the following were assessed: shopping for groceries, driving or using public transportation, using the telephone, meal preparation, housework, home repair, laundry, taking medication, handling finances] - Result of assessment using a standardized functional status assessment tool - Notation that at least three of the following four components were assessed: cognitive status; ambulation status; hearing, vision and speech (sensory ability) ; other functional independence (exercise, ability to perform job) Pain Assessment - Notations for pain assessment must include one of the following: - Documentation that the member was assessed for pain (positive or negative finding) - Result of assessment using a standardized assessment tool A pain management/treatment plan alone does not count. Either does screening for chest pain or positive chest pain alone. Breast Cancer Screening Codes CPT Codes: HCPCS G0202, G0204, G0206 UB Rev Codes 0401, 0403 Mastectomy Codes ICD-10CM Code: Z90.13, or Z90.12 and Z90.11 ICD-10PCS Code: 0HTV0ZZ, or 0HTU0ZZ and 0HTT0ZZ CPT Codes: , 19220, 19240, with a Bilateral Modifier CPT Codes: 50, or LT and RT CPT Codes: 99495, CPT II Codes: 1111F Advance Care Planning CPT: CPT II: 1157F, 1158F HCPCS: S0257 Medication Review CPT: 90863, 99605, 99606, 99494, CPT II: 1160F Medication List CPT ll: 1159F HCPCS: G8427 Functional Status Assessment CPT II: 1170F Pain Assessment CPT II: 1125F, 1126F Aetna HEDIS Tip Sheet 2017 Page 1

2 CBP - Controlling High Blood Pressure Members years of age with a diagnosis of hypertension (HTN) and whose BP is adequately controlled. Age and age with diabetes <140/90 Age without diabetes <150/90). CDC Comprehensive Diabetes Care Members years of age with diabetes should have each of the following at least annually: HbA1C testing, medical attention for nephropathy, a retinal eye exam and blood pressure monitoring at each visit. AAP - Adults Access to Preventive/ Ambulatory Health Services Members 20 years and older who had an ambulatory or preventive care visit during the year. PSA Non-Recommended PSA-Based Screening in Older men Men 70 years and older who were screened unnecessarily for prostate cancer using prostate-specific antigen (PSA)- based screening. A lower rate indicates better performance ART - Disease-Modifying Anti-rheumatic Drug Therapy for Rheumatoid Arthritis Members 18 years of age or older who were diagnosed with rheumatoid arthritis and were prescribed a disease-modifying anti-rheumatic drug (DMARD). If BP elevated (140/90 or greater) at initial vital sign assessment, alleviate potential factors that might cause temporary elevation and retake BP during exam. Make sure you use the correct size cuff If using a machine, record the actual number, do NOT round up. Schedule follow up visits to monitor effectiveness of BP medication. Order screenings annually or more often as needed and educate member on importance. Include all current medications on the medication list. Be sure to indicate if a member is on an ACE/ARB medication Document Stage 4 chronic kidney disease or End State Renal Disease (ESRD) with appropriate codes: Stage 4 chronic kidney disease CD-10 CM: N18.4 ESRD ICD-10 CM: N18.5, N18.6, Z91.15, Z99.2 ICD -10 PCS: 3E1M39Z, 5A1D00Z, 5A1D60Z Refer member to Optometrist for Dilated Retinal Eye Exam annually. Each adult member should have a routine outpatient visit annually. Utilize your Gaps in Care report to outreach members that have not had care. Total population PSA testing is not currently advised for men 70 years and older. The exclusions to this measure are men with a prostate cancer diagnosis at any time, dysplasia of the prostate during the measurement year and year prior, anyone that had a PSA test during the year prior to the measurement year with an elevated result (>4.0 ng/ml), or anyone dispensed a prescription for 5-alpha reductase inhibitor during the measurement year. Prescribe DMARDs to members with rheumatoid arthritis. Exclusions: A diagnosis of HIV anytime during the member s history through the end of them measurement year or a diagnosis of pregnancy in the measurement year ICD-10 CM Code: I10 Exclusions: End Stage Renal Disease (ESRD) or a kidney transplant on or prior to December 31st of the measurement year or a diagnosis of pregnancy during the measurement year, would be excluded from this measure. Diabetes ICD-10 CM Codes: E10.10-E13.9, O O24.33, O O24.83 Diabetes without complications ICD-10 CM: E10.9, E11.9, E13.9 HbA1c CPT Codes: 83036, HbA1c LOINC: , , CPTII Result Codes HbA1c level : 3045F HbA1c level less than 7.0: 3044F HbA1c level greater than 9.0: 3046F Urine Protein Tests CPT Codes: , 81005, , CPT II Codes: 3060F-3062F Blood Pressure CPT Codes: Systolic BP: < F, 3075F ; >/= to F Diastolic BP: F; < F; >/= F CPT: , , UB Rev Codes: 051X, , 0982, 0983 Preventive Medicine CPT: , , , 99411, 99412, 99420, HCPCS: G0402, G0438, G0439, G0463, T1015 General medical examination ICD-10: Z00.00, Z00.01, Z00.121, Z00.129, Z00.5, Z00.8, Z02.0-Z02.6, Z02.71, Z02.79, Z02.81-Z02.83, Z02.89, Z02.9 Home Services CPT: , Nursing Facility Care CPT: , 99315, 99316, Domiciliary, rest home or custodial care services CPT: , Prostate Cancer ICD 10: C61, D07.5, D40.0, Z15.03, Z85.46 Prostate Dysplasia ICD 10: N42.3 ICD-10 CM Codes: M05.00-M06.9 DMARD HCPCS: J0129, J0135, J0717, J1438, J1600, J1602, J1745, J3262, J7502, J7515-J7518, J9250, J9260, J9310 Aetna HEDIS Tip Sheet 2017 Page 2

3 OMW - Osteoporosis Management in Women Who Had a Fracture Women years of age who suffered a fracture and had either a bone mineral density test or were prescribed a drug to treat osteoporosis in the 6 months after a fracture. SPR -Use of Spirometry Testing in the Assessment and Diagnosis of COPD Members age 40years or older with a new diagnose of COPD or newly active COPD, who received appropriate spirometry to confirm the diagnosis. PCE - Pharmacotherapy Management of COPD Exacerbation Members age 40 and older who had an acute IP stay or ED visit with a diagnosis of COPD exacerbation and were dispensed appropriate medications. Two rates are reported: 1. Dispensed a systemic corticosteroid (or evidence of an active prescription within 14 days of the event 2. Dispensed a bronchodilator (or evidence of an active prescription) within 30 days of the event. MMA Medication Management for People With Asthma Members age 5-85, identified as having persistent asthma and dispensed appropriate medications that they remained on during the treatment period (end of calendar year) Two rates reported: 1. Remained on asthma controller medication for at least 50% of the treatment period. 2. Remained on asthma controller medication for at least 75% of the treatment period. ABA - Adult BMI Assessment Members years of age who had their body mass index (BMI) and weight documented at least every other year. Schedule women age years old for a bone mineral density test (BMD) within six months after a fracture if they have not had a BMD test in the prior 24 months. Prescribe medications to treat osteoporosis when indicated. Educate members that are newly diagnosed with COPD or newly active COPD about the importance of spirometry testing Submit timely claims for spirometry testing performed in your office. Schedule follow-up appointments with these members within a few days of their hospital discharge or ED visit Medication reconciliation is key Member education to include filling the prescriptions, appropriate use and side effects Order medications that are on the member s health plan formulary Schedule regular follow-up for people with persistent asthma Patient education about benefits of medication compliance Order medications that are on the Member s health plan formulary Perform and document Ht/Wt/BMI calculation at each visit or at least annually. Patients younger than 20 years old need to have a BMI percentile documented *Pregnant members are excluded from this measure* Bone Density: CPT Codes :76977, 77078, , ICD-10 PCS Codes: BP48ZZ1, BP49ZZ1, BP4GZZ1, BP4HZZ1, BP4LZZ1, BP4MZZ1, BP4NZZ1, BP4PZZ1, BQ00Z- ZI, BQ01ZZ1, BQ03ZZ1, BQ04ZZ1, BR00ZZ1, BR07ZZ1, BR09ZZ1, BR0GZZ1 HCPCS G0130 Osteoporosis Medications J0630, J0897, J3110, J1740, J3487-J3489, Q2051 COPD ICD-10 Codes: J44.0, J44.1, J44.9, Chronic Bronchitis ICD-10CM: J41.0, J41.1, J41.8, J42 Emphysema ICD-10 CM Codes: J43- J43.0, J43.8, J43.9 Spirometry CPT Codes: 94010, , 94060, 94070, 94375, Systemic Corticosteroids - Glucocorticosteroids - Betamethasone, Dexamethasone, Hydrocortisone, Methylprednisolone, Prednisolone, Prednisone, Triamcinolone Bronchodilators- Anticholinergic Agents - Albuterol-ipratropium, Ipratropium, Aclidinium-bromide, Tiotropium, Umeclidium Beta 2-agonists - Albuterol, Levalbuterol, Arformoterol, Mometasone-formoterol, Budesonide-formoterol, Metaproterenol, Fluticasone-salmeterol, Olodaterolhydrochloride, Olodaterol-tiotropium, Fluticasonevilanterol, Pirbuterol, Formoterol, Salmeterol, Indacaterol, Umeclidinium-vilanterol Methylxanthines - Aminophylline, Dyphylline, Dyphyllineguaifenesin, Theophylline, Guaifenesis-theophylline Asthma Controller Medications Antiasthmatic Combinations - Dyphylline-guaifenesin, Guaifenesin-theophylline Antibody Inhibitor - Omalizumab Inhaled Steroid Combinations - Budesonide-formoterol, Mometasone-formoterol, Fluticasone-salmeterol Inhaled Corticosteroids - Beclomethasone, Budesonide, Ciclesonide, Flunisolide, Fluticasone CFC free, Mometasone Leukotriene Modifiers - Montelukast, Zafirlukast, Zileuton Mast Cell Stabilizers - Cromolyn Methylxanthines - Aminophylline, Dyphylline, Theophylline Exclusion ICD-10 CM Codes Acute Respiratory Failure: J96.00-J96.02, J96.20-J96.22 Chronic Respiratory Conditions due to Fumes/Vapors: J68.4 COPD: J44.0, J44.1, J44.9 Cystic Fibrosis: E84.0, E84.11, E84.19, E84.8, E84.9 Emphysema: J43.0-J43.2, J43.8-J43.9 Other Emphysema: J98.2, J98.3 ICD-10 CM Codes: BMI Z68.1, Z68.20-Z68.29, Z68.30-Z68.39, Z Z68.45 BMI Percentile Z68.51-Z68.54 Aetna HEDIS Tip Sheet 2017 Page 3

4 AMM - Antidepressant Medication Management Patients 18 years of age and older who were newly treated with antidepressant medication, had a diagnosis of major depression and who remained on antidepressant medication treatment. Two rates are reported: Effective Acute Phase: Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks) Effective Continuation Phase: Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months) CCS - Cervical Cancer Screening Women years of age with one or more Pap tests within the last 3 years or for women years of age, a cervical cytology and human papillomavirus (HPV) cotesting with in the last 5 years. COL - Colorectal Cancer Screening Adults years of age with an appropriate screening for colorectal cancer. PBH - Persistence of Beta-Blocker Treatment After a Heart Attack Members 18 years of age and older who were hospitalized and discharged with a diagnosis of AMI and received persistent beta-blocker treatment for six months after discharge. Educate patients that medication may take several weeks to become effective, they should call with any medication concerns/ reactions Stress that they should not stop medication abruptly or without consulting you first for assistance Schedule follow up appointments prior to patient leaving your office Outreach patients that cancel appointments and have not rescheduled Stress the importance of medication compliance. Share tips to help them remember to take their medication. Women who have had a total hysterectomy with no residual cervix are excluded. This must be documented in the history or problem list. Notation of Pap test located in progress notes MUST include the lab results in order to meet NCQA requirements. Reflex testing: performing HPV test after determining cytology result, does not count. Cervical cytology and human papillomavirus test must be completed four or less days apart in order to qualify for every 5 year testing. Educate members on importance of screening to enable early detection of colon cancer. Any of the following meet compliance of done in the correct time period: Colonoscopy: Flexible sigmoidoscopy: CT colonography: FIT-DNA test : Fecal occult blood test (3 samples): 2016 A guaiac test in the office during a rectal exam does not count. Members with colorectal cancer or a history of a total colectomy are excluded. Document accordingly. Stress the importance of medication compliance and why they need to take a beta blocker at follow-up visits. Advise member not to stop medication without talking with provider first. Consider ordering a 90 day supply if permitted by member s benefit. There are exclusions for intolerance or allergy to beta blockers as well as conditions listed in next column. ICD-10 CM Codes for Major Depression: F32.0-F32.4, F32.9, F33.0-F33.3, F33.41, F33.9 Cervical Cytology CPT Codes: , 88147, 88148, 88150, , , 88174, HCPCS: G0123, G0124, G0141, G0143-G0145, G0147, G0148, P3000, P3001, Q0091 UB Rev Codes : 0923 LOINC Codes: , , , , , , , , , HPV CPT Codes: , HCPCS: G0476 LOINC Codes: , , , , , , , , , , , , , Colonoscopy CPT Codes: , 44397, , 45355, , ICD-9 PCS Codes: 45.22, 45.23, 45.25, 45.42, HCPCS G0105, G0121 Flexible Sigmoidoscopy CPT Codes: , , , ICD-9 PCS Code: HCPCS: G0104 CT Colonography CPT Code: FIT-DNA test CPT Code: HCPCS: G0464 LOINC: , Fecal Occult Blood Test (FOBT) CPT Codes: 82270, HCPCS: G0328 LOINC: , , , , , , , , , , , , , , , ICD-10 Codes to Identify Exclusions: History of Asthma: J45.20-J COPD: J44.0, J44.1, J44.9 Chronic Respiratory Conditions due to Fumes/ Vapors: J68.4 Hypotension: I95.0-I95.9 Heart Block > 1st degree: l44.1-i44.7, I45.10-I45.3, I45.6, I49.5 Sinus Bradycardia: R00.1 Aetna HEDIS Tip Sheet 2017 Page 4

5 SPC Statin Therapy for Patients with Cardiovascular Disease Males years of age and females years of age, who were identified as having clinical atherosclerotic cardiovascular disease (ASCVD) and met the following criteria. The following rates are reported: Received Statin Therapy. Members who were dispensed at least one high or moderate-intensity statin medication during the measurement year. Statin Adherence 80%. Members who remained on a high or moderateintensity statin medication for at least 80% of the treatment period. (RX date through end of year). SPD Statin Therapy for Patients With Diabetes Patients years of age during the measurement year with diabetes who do not have clinical atherosclerotic cardiovascular disease (ASCVD) who met the following criteria. Two rates are reported: Received Statin Therapy. Dispensed at least one statin medication of any intensity during the year Statin Adherence 80%. Remained on a statin medication of any intensity for at least 80% of the treatment period (Rx date through end of year. Educate patients about the importance of statin therapy Educate patients on side effects and importance of reporting any side effects to you so their medication can be adjusted/changed if necessary Advise patients not to stop taking without consulting you Exclusions do apply for members pregnant or undergoing IVF or Rx for clomiphene during the measurement year or year prior Dx of ESRD or Cirrhosis during the measurement year or year prior Myalgia, myositis, myopathy or rhabdomyolysis during the measurement year. Educate patients about the importance of statin therapy in patients with diabetes Educate patients on side effects and importance of reporting any side effects to you so medication can be adjusted/changed Advise patients not to stop taking without consulting you In addition to the exclusions noted above in the SPC measure, members are excluded with cardiovascular disease. High-intensity statin therapy Atorvastatin mg Rosuvastatin 20-40mg Amlodipine-atorvastatin mg Simvastatin 80mg Ezetimibe-atorvastatin 10-20mg Ezetimibe-simvastatin 80 mg Moderate-intensity statin therapy Atorvastatin mg Lovastatin 40 mg Amlodipine-atorvastatin mg Ezetimibe-atorvastatin mg Sitagliptin-simvastatin mg Pravastatin 40-80mg Rosuvastatin 5-10mg Ezemtimibe-simvastatin 20-40mg Niacin-simvastatin 20-40mg Niacin-lovastatin 40mg Fluvastatin XL 80mg Fluvastatin 40 mg BID Pitavastatin 2-4 mg In addition to the high and moderate intensity statins listed above, the following low-intensity statins pertain to this measure: Simvastatin 10 mg Lovastatin 20 mg Ezemtimibe-simvastatin 10 mg Niacin-lovastatin 20 mg Sitagliptin-simvastatin 10mg Fluvastatin mg Pravastatin mg Pitavastatin 1 mg DDE Potentially Harmful Drug-Disease Interactions in the Elderly The percentage of Medicare members 65 years of age and older who have evidence of an underlying disease, condition or health concern and who were dispensed an ambulatory prescription for a potentially harmful medication, concurrent with or after the diagnosis. Three rates reported: 1. A history of falls and a prescription for anticonvulsants, SSRIs, antipsychotics, benzodiazepines, non-benzodiazepine hypnotics or tricyclic antidepressants. 2. Dementia and a prescription for antipsychotics, benzodiazepines, nonbenzodiazepine hypnotics, tricyclic antidepressants, H 2 receptor antagonists or anticholinergic agents. 3. Chronic kidney disease and prescription for Cox-2 selective NSAIDs or nonaspirin NSAIDs Carefully review patient s history before prescribing anticonvulsants, SSRIs, antipsychotics, benzodiazepines, non-benzodiazepine hypnotics or tricyclic antidepressants. Patients with an accidental fall or hip fracture in the past 2 years are at an increased risk if taking these medications. There are exclusions for this measure: patients with a diagnosis of psychosis, schizophrenia, bipolar disorder, or seizure disorder during the 2 year period. Carefully review patient s history before prescribing any antipsychotics, benzodiazepines, non-benzodiazepine hypnotics, tricyclic antidepressants, H 2 receptor antagonists or anticholinergic agents. Patients with a diagnosis of dementia in the past two years have increased risk. There are exclusions for this measure: patients with a diagnosis of psychosis, schizophrenia or bipolar disorder during the 2 year period. Review patient history for CKD, ESRD or kidney transplant before ordering any Cox-2 selective NSAIDs or nonaspirin NSAIDs Falls and Hip Fracture: Any fall or Hip Fracture ICD10 or CPT code is pulled into the denominator Dementia: ICD 10: F01.50, F01.51, F02.80, F02.81, F03.90, F03.91, F04, F10.27, F10.97, F13.27, F13.97, F18.17, F18.27, F18.97, F19.17, F19.27, F19.97, G30.0, G30.1, G30.8, G30.9, G31.83 Refer to the list of medications attached Chronic Kidney Disease Stage 4 ICD 10: N18.4 ESRD CPT: 36147, 36800, 36810, 36815, , , 90935, 90937, 90940, 90945, 90947, , 90965, 90966, 90969, 90970, 90989, 90993, 90997, 90999, HCPCS: G0257, S9339 ICD 10 CM: N18.5, N18.6, Z91.15, Z99.2 ICD10 PCS : 3E1M39Z, 5A1D00Z, 5A1D60Z Kidney Transplant CPT: 50300, 50320, 50340, 50360, 50365, 50370, HCPCS: S2065 ICD10CM: Z94.0 ICD10PCS: 0TY00Z0, OTY00Z2, 0TY10Z0, 0TY10Z1, 0TY10Z2 Aetna HEDIS Tip Sheet 2017 Page 5

6 DAE Use of High-Risk Medication in the Elderly The percentage of Medicare members 66 years of age and older who had at least one dispensing event for a high-risk medication. The percentage of Medicare members 66 years of age and older who had at least two dispensing events for the same high -risk medication. For both rates, a lower rate represents better performance. MPM Annual Monitoring for Patients on Persistent Medications Members 18 years of age and older who received at least 180 treatment days of ambulatory medication therapy for a select therapeutic agent during the measurement year and at least one therapeutic monitoring event for the therapeutic agent in the measurement year. Annual monitoring for members on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB). at least one serum K+ and serum Cr during the year Annual monitoring for members on digoxin. at least one serum K+, serum Cr and digoxin level during the year Annual monitoring for members on diuretics at least one serum K+ and serum Cr during the year Always complete a thorough medication review and re-evaluate the use of high risk drugs at each visit. Monitor adverse side effects and possibility of it being misinterpreted as a new diagnosis or symptom. Whenever possible, avoid prescribing these medications for patients over age 66 Educate patients on the importance of lab work when taking certain medications Check each visit to see if lab work has been completed, if not re-educate and reorder Refer to attached list of medications considered high risk in the elderly. CPT Codes Lab panels that include K+ and CR 80047, 80048, 80050, 80053, Serum K , Serum Cr 82565, Digoxin Level Total rate (the sum of the three numerators divided by the sum of the three denominators Data collected through member surveys for members 65 years and older: - Fall Risk Management - Management of Urinary Incontinence in Older Adults - Osteoporosis Testing in Older Women - Physical Activity in Older Adults Other data collected though surveys : - Aspirin Use and Discussion - Flu Vaccination for Adults - Medical Assistance With Smoking and Tobacco Use Cessation - Pneumococcal Vaccination Status for Older Adults Talk to your patients about these topics Ask patients if they are having problems with balance or walking. If they are, make recommendations for how to prevent falls or treat balance/walking issues Ask patients if they are having any urinary leakage and discuss treatment options if they are. Be sure to ask if it is interfering with their daily activities or sleep and address those issues. Discuss bone mineral density testing with women over 65 and order a screen if they have never had one. Ask patients about their level of exercise or physical activity and advise on starting, increasing or maintaining that level. More Tips: Ask patients if they are taking a daily aspirin and discuss the risks and benefits of using it. Encourage all patients to get a flu shot annually unless it is contraindicated. Ask you patients if they smoke. If they do, advise them to quit, discuss cessation medications and other quitting strategies. Encourage patients over 65 to get the pneumococcal vaccine unless contraindicated. Aetna HEDIS Tip Sheet 2017 Page 6

7 Potentially Harmful Drugs - Rate 1 Description Prescription Anticonvulsants SSRIs Carbamazepine Clobazam Divalproex sodium Ethosuximide Ethotoin Ezogabine Felbamate Citalopram Escitalopram DDE Measure Medications for Rates 1 and 2 Fosphenytoin Gabapentin Lacosamide Lamotrigine Levetiracetam Mephobarbital Methsuximide Fluoxetine Fluvoxamine Oxcarbazepine Phenobarbital Phenytoin Pregabalin Primidone Rufinamide Tiagabine HCL Paroxetine Sertraline Topiramate Valproate sodium Valproic acid Vigabatrin Zonisamide Potentially Harmful Drugs - Rates 1 & 2 Description Prescription Aripiprazole Asenapine Brexpiprazole Antipsychotics Cariprazine Chlorpromazine Clozapine Benzodiazepines Nonbenzodiazepine hypnotics Tricyclic antidepressants Alprazolam Chlordiazepoxide products Clonazepam Clorazepatedipotassium Fluphenazine Haloperidol Iloperidone Loxapine Lurasidone Molindone Diazepam Estazolam Flurazepam HCL Olanzapine Paliperidone Perphenazine Pimozide Quetiapine Risperidone Lorazepam Midazolam HCL Oxazepam Eszopiclone Zaleplon Zolpidem Amitriptyline Amoxapine Clomipramine Desipramine Doxepin (>6 mg) Imipramine Nortriptyline Thioridazine Thiothixene Trifluoperazine Ziprasidone Quazepam Temazepam Triazolam Protriptyline Trimipramine Potentially Harnful Drugs - Rate 2 Description Presciption H 2 receptor antagonists Cimetidine Famotidine Nizatidine Ranitidine antiemetics antihistamines antispasmodics antimuscarinics (oral) anti-parkinson agents Prochlorperazine Promethazine Carbinoxamine Chlorpheniramine Hydroxyzine Brompheniramine Atropine Homatropine Darifenacin Fesoterodine Clemastine Triprolidine Cyproheptadine Belladonna alkaloids Dicyclomine Trospium Flavoxate Benztropine Trihexyphenidyl Dimenhydrinate Diphenhydramine Meclizine Hyoscyamine Propantheline Oxybutynin Tolterodine Dexbrompheniramine Dexchlorpheniramine Doxylamine Scopolamine Clidiniumchlordiazepoxide Solifenacin skeletal muscle relaxants SSRIs or antiarrhythmic Cyclobenzaprine Orphenadrine Paroxetine Disopyramide Aetna HEDIS Tip Sheet 2017 Page 7

8 DAE Measure Medications High-Risk Medications Prescriptions Anticholinergics, first-generation antihistamines Brompheniramine Carbinoxamine Chlorpheniramine Clemastine Cyproheptadine Dexbrompheniramine Dexchlorpheniramine Diphenhydramine (oral) Dimenhydrinate Doxylamine Hydroxyzine Meclizine Promethazine Triprolidine Anticholinergics, anti-parkinson agents Benztropine (oral) Trihexyphenidyl Antispasmodics Antithrombotics Atropine (exclude ophthalmic) Belladonna alkaloids Clidinium-chlordiazepoxide Dicyclomine Dipyridamole, oral short-acting (does not apply to the extendedrelease combination with aspirin) Hyoscyamine Propantheline Scopolamine Ticlopidine Guanabenz Methyldopa Cardiovascular, alpha agonists, central Guanfacine Cardiovascular, other Disopyramide Nifedipine, immediate release Central nervous system, antidepressants Central nervous system, barbiturates Amitriptyline Clomipramine Amoxapine Desipramine Imipramine Amobarbital Butabarbital Butalbital Mephobarbital Trimipramine Nortriptyline Paroxetine Protriptyline Pentobarbital Phenobarbital Secobarbital Central nervous system, vasodilators Ergot mesylates Isoxsuprine Central nervous system, other Meprobamate Endocrine system, estrogens with or without progestins; include only oral and topical patch products Conjugated estrogen Esterified estrogen Estradiol Estropipate Endocrine system, sulfonylureas, long-duration Chlorpropamide Glyburide Endocrine system, other Desiccated thyroid Megestrol Pain medications, skeletal muscle relaxants Pain medications, other Carisoprodol Chlorzoxazone Cyclobenzaprine Indomethacin Ketorolac, includes parenteral Metaxalone Methocarbamol Orphenadrine Meperidine Pentazocine High-Risk Medications With Days Supply Criteria Prescriptions Days Supply Criteria Anti-Infectives, other Nitrofurantoin Nitrofurantoin macrocrystals Nitrofurantoin macrocrystalsmonohydrate > 90 days Nonbenzodiazepine hypnotics Eszopiclone Zaleplon Zolpidem > 90 days High-Risk Medications With Average Daily Dose Criteria Prescriptions Average Daily Dose Criteria Alpha agonists, central Reserpine >0.1 mg/day Cardiovascular, other Digoxin >0.125 mg/day Tertiary TCAs (as single agent or as part of combination products) Doxepin >6 mg/day Aetna HEDIS Tip Sheet 2017 Page 8