Pharmacy Quality Initiatives

HPV vaccine in pre-teens/teens is essential.

The American Academy of Pediatrics (AAP) recommends routine HPV vaccination for females and males. The AAP recommends starting the series between 9 and 12 years, at an age that the provider deems optimal for acceptance and completion of the vaccination series.

HPV vaccine has an outstanding safety profile

It is our responsibility as health providers to ensure that our families have the information they seek regarding this vaccine and its safety profile.

It is reported in “Trends in Reasons for Human Papillomavirus Vaccine Hesitancy: 2010-2020,” (Adjei Boakye E, et al. Pediatrics. May 23, 2023) that parents express more hesitancy now related to concerns for safety than previously.

Many experts attribute this increased hesitancy to social media anti-vaccine campaigns.

We know that amid all the current health mandates providers have much to discuss with families, but please be sure that you support and remind parents of the need for both the initial vaccine and the booster 5 months after the initial vaccine.

Buckeye Health Plan is partnering with you in this effort and we stand ready to remind families of this medical need and support you as you educate your patients regarding the HPV vaccine.

Be SMART with Asthma

Have you heard of SMART?

SMART stands for Single Maintenance and Reliever Therapy and is currently recommended in patients 4 years of age and older with moderate to severe asthma. This type of asthma treatment involves the use of one inhaler that includes an inhaled corticosteroid (ICS) and a long-acting beta agonist (LABA), specifically formoterol, for both maintenance and reliever therapy.

According to the Asthma Management Guidelines updated in 2020 by the National Heart, Lung, and Blood Institute (NHLBI), patients on daily ICS-LABA treatment plus as needed short-acting beta agonist (SABA) that are uncontrolled may benefit from SMART. Evidence supports switching to SMART at the same or lower maintenance ICS-LABA dose before considering a step up in maintenance treatment. If patients are well controlled on the ICS-LABA plus SABA treatment, SMART may offer less added benefit; thus, the regimen should be maintained. Additionally, the Global Initiative for Asthma (GINA) guidelines were updated in May of 2024 to clarify and continue support for SMART for moderate to severe asthma from its initial inclusion in the December 2022 update of the GINA guidelines.

Based on the current evidence and continued studies, the decrease in medication burden and reduction in medication costs for patients with asthma by utilizing SMART is clinically significant. Here are some important points for all clinicians to keep in mind:

1. Traditional asthma management uses different medications for maintenance and reliever therapy whereas SMART uses the same medication for BOTH!
2. SMART may reduce the risk of confusion on which inhaler to use for maintenance or reliever for many patients, especially children.
3. SMART is part of the National Asthma Education and Prevention Program (NAEPP) and is detailed in the 2020 NHLBI and 2024 GINA guidelines.
4. If symptoms are well controlled with two inhalers, it is appropriate to maintain that regimen; but SMART is recommended for patients with moderate to severe persistent asthma aged 4 years and older.
5. SMART medications are FDA approved in patients 12 years or older and guidelines recommend off-label use of SMART in children aged 4 to 11 years.
6. In relation to the Asthma Medication Ratio (AMR) HEDIS measure, low dose ICS/LABA (formoterol) combinations are considered ‘Asthma Controller Medications’ and, when filled, lead to a higher percentage of ‘Asthma Controller Medications’ over ‘Total Asthma Medications’. This results in a higher AMR compliance rate; thus, the use of only one inhaler for those with moderate to severe asthma may enhance patient compliance while potentially decreasing exacerbations and lowering costs simultaneously.

RESOURCES:

1.      Allergy Asthma Network

2.      Community.AAFA.Org

3.      Allergy Asthma Network.org

4.      Gina Pocket Guide (PDF)

5.      2024 Gina Main Report

6.      ATS Journals

7.      National Library of Medicine

8.     JAMA Network

9.    Pharmacy Times

10.  SPBM.Medicaid.Ohio.Gov

11.  SPBM.Medicaid.Ohio.Gov (PDF)

12.  SPBM.Medicaid.Ohio.Gov Document Library (PDF)

AMR: Asthma Medication Ratio

Asthma Medication Ratio (AMR) is a HEDIS measure that focuses on patients with persistent asthma and looks at the number of their controller medication fills in relation to total asthma medication fills (rescue and controller). 

Did you know?

• In 2023, current asthma rates in Ohio were 159,955 (6.8%) in children and 1,007,049 (11.0 %) in adults. ¹
• Up to 80% of patients cannot use their inhaler correctly!
• At least 50% of adults and children do NOT take controller medications as prescribed.
• Regular use of SABA (short acting beta agonist), even for 1-2 weeks, is associated with increased AHR (airway hyperresponsiveness), reduced bronchodilator effect, increased allergic response, and increased eosinophils. This can lead to a vicious cycle encouraging overuse. Overuse of SABA is associated with increased exacerbations and increased mortality. ²
• GINA (Global Initiative for Asthma) does not recommend treatment of asthma in adults, adolescents, or children 6-11 years with short-acting beta2 agonist (SABA) alone. Instead, they should receive inhaled corticosteroid (ICS)-containing treatment to reduce their risk of severe exacerbations and to control symptoms.²

Currently Buckeye Health Plan (BHP) has in place the following initiatives:

1. In conjunction with our data analytics team, a daily report is generated that identifies BHP members who are non-adherent to their asthma controller medications as well as those filling multiple rescue inhalers.
2. Our pharmacy team makes fax attempts as well as phone outreaches to providers, including topics such as non-adherence to controller medications, extended day supplies, those with no controller medications, and multiple rescue inhaler fills.
3. Our pharmacy team also sends out text messages to members who are non-adherent to their asthma controller medications, reminding them that their medication is important in controlling their asthma.  
4. In addition, our pharmacy team also sends out educational text messages to our asthma members regarding topics such as asthma triggers, smoking cessation, children having inhalers at school, SMART, and vaccinations.   

Please consider the following:

1. During each visit with the member, review their medication list and ask if there are any issues with filling or taking medications as prescribed.
2. Provide an asthma action plan if the member does not already have one.  
3. Discuss with members the difference between their rescue inhalers and controller inhalers/medications and make sure they understand how and when to use each.  
4. Consider prescribing a spacer with a mask to ensure the member is using their inhaler correctly and getting the full dose.
5. Address medication therapy if a member is overutilizing their rescue inhaler.
6. Determine if SMART (Single Maintenance and Reliever Therapy) may be appropriate for a member.
7. Offer an extended day supply of medications to help improve adherence and lessen member trips to the pharmacy.
8. Continue to monitor a member’s progress and follow up as needed.

References:

1. American Lung Association. (2025). Asthma Trends and Burden. 
2. Global Initiative For Asthma (GINA). (2025). 

Our Mission

This task force will be responsible for establishing the evidence based multi-disciplinary interventions that Buckeye Health Plan will engage in to combat the opioid epidemic in Ohio. 

Desired Outcomes

• To reduce the residential treatment 30-day readmission rate from 4.4% to 4.0% by 12/31/2024.
• To improve timely access to care following an emergency department visit for a substance use disorder as measured by meeting or exceeding the 75th percentile for FUA HEDIS 7 (27.90%) and 30 (42.55%) Day by 12/31/2024. 
• To sculpt our network of substance use disorder providers to contract with high quality providers as measured by 75th percentile or greater for HEDIS measure IET, HDO, UOP, COU, and POD.
• To increase the percentage of members with Opioid use disorder being treated with medication-assisted therapy (MAT) by 10% from 7/1/23 to 7/1/26.
• To decrease members who are overdosing from unintentional opiate related drug use by 5% by 12/31/2024.

Resources

• Morphine Equivalent Dose (MED) Calculator - Ohio State Board of Pharmacy
• Online Education and Practice Tools: Pri-Med

As part of the initiative to combat the opioid epidemic, Buckeye Health Plan has adopted a Drug Management Program (DMP) for beneficiaries at-risk for misuse or abuse of frequently abused medications.

Background:

Section 704 of the Comprehensive Addiction and Recovery Act (CARA) of 2016 included provisions permitting Part D sponsors to establish Drug Management Programs (DMPs) for beneficiaries at-risk for misuse or abuse of frequently abused drugs (FADs).

CMS published a final rule (CMS-4182-F) on April 16, 2018 (“final rule”) that established the framework under which Part D plan sponsors may establish a DMP. This rule codified the many aspects of the retrospective Part D Opioid Drug Utilization Review (DUR) Policy and Overutilization Monitoring System (OMS), with adjustments as needed to comply with CARA, by integrating them into the DMP provisions at 42 CFR § 423.153(f).

Starting in January 2019, sponsors that adopted a DMP must engage in the case management of each Potential At-Risk Beneficiary (PARB) reported through OMS and provide information related to their review within 30 days. In addition, sponsors must also report through OMS any sponsor-identified PARBs, and any newly enrolled PARBs or At-Risk Beneficiaries (ARBs) for which a sponsor received a transaction reply code (TRC) of ‘376’ (New Enrollee CARA Status Notification) from the daily transaction reply report (DTRR).

See additional DMP guidance on the CMS Part D Overutilization website.

CMS policies also include drug management programs to encourage care coordination and safe use of opioids as required by the Comprehensive Addiction and Recovery Act of 2016. Starting in 2019, for patients who could potentially abuse or misuse prescription drugs - including opioids and benzodiazepines - a Medicare drug plan will contact prescribers through case management to review patients’ total utilization pattern of frequently abused drugs and discuss the following :

1. Use of opioids with an average daily morphine milligram equivalent (MME) equal to or exceeding 90 mg for any duration during the most recent 6 months and either: 3 or more opioid prescribers and 3 or more opioid dispensing pharmacies OR 5 or more opioid prescribers, regardless of the number of opioid dispensing pharmacies. These cases are identified through OMS or by sponsors.

2.  Use of opioids (regardless of average daily MME) during the most recent 6 months with 7 or more opioid prescribers OR 7 or more opioid dispensing pharmacies. These cases are identified by sponsors.

SPC: Statin Therapy for Patients with Cardiovascular Disease

Product Line: Medicaid, Medicare, Marketplace

Statin Therapy for Patients with Cardiovascular Disease (SPC) is a HEDIS measure that focuses on patients and their adherence to at least one high or moderate-intensity statin medication therapy during the measurement year.  

Service Needed

Male patients 21-75 years of age and female patients 40-75 years of age, with a diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD) and being treated with and remain taking a high or moderate-intensity statin medication.

Two rates reported for this measure are:

1. The percentage of patients who are dispensed at least one high or moderate-intensity statin medication during the measurement year.
2. Percentage of patients who remain on a high or moderate-intensity statin medication for at least 80 percent of the treatment period.

Tips for Attainment:

• At each visit, review the medication list and ask if there are any issues with filling or taking medications as prescribed. If there are any problems/issues with the medication, open-ended questions will assist you with solutions and remove patient barriers to adherence.
• Educate members on the purpose of the medication, including how often to take the medication and possible side effects. Advise member to contact provider's office if side effects occur or are suspected.
• Assess health literacy to determine need for additional support in medication management.
• Offer a 100-day supply of medication to members, if stable.
• Encourage member to sign up with their retail or mail-order pharmacy.
• Reminder calls, emails, text messages or mailings can assist with ensuring members do not miss scheduled appointments.
• Schedule an annual visit or follow-up visit before the member leaves the office.
• Ensure member completes any required labs such as cholesterol, kidney values (both blood and urine) and/or A1c

Buckeye Initiatives:

Weekly Outreach

1. Data analytics team generates weekly report identifying BHP members with diagnosis of ASCVD and no record of statin therapy
2. Pharmacy team makes up to 2 fax attempts to each provider for each identified member to request provider to evaluate if statin therapy is appropriate for member
3. No response from fax outreach, then Buckeye clinical pharmacist (when appropriate) attempts to contact provider to review and resolve the opportunity.
4. For members currently taking statin therapy but fall below 80% adherence – fax outreach is made to provider to alert them that member is non-adherent to their statin therapy. Cardiovascular disease (CVD) is the leading cause of morbidity and death in the US, resulting in more than 1 of every 4 deaths.1 Coronary heart disease is the single leading cause of death and accounts for 43% of deaths attributable to CVD in the US.

In 2019, an estimated 558 000 deaths were caused by coronary heart disease and 109 000 deaths were caused by ischemic stroke. Men have a higher overall prevalence of and mortality from CVD, although women experience higher mortality from certain cardiovascular events, such as stroke. On average, men experience CVD events earlier in life compared with women. The prevalence of CVD also differs by race and ethnicity. Among both sexes, Black adults have the highest prevalence of CVD.

Statin Use for the Primary Prevention of Cardiovascular Disease in Adults
2024 Heart Disease and Stroke Statistics Update Fact Sheet (PDF)

For more information and improvement tips see the SPC page of our HEDIS Reference Guide (PDF).

SPD: Statin Therapy for Patients with Diabetes (SUPD below)

Product Line: Medicaid, Medicare, Marketplace

Statin Therapy for Patients with Diabetes is a HEDIS measure that focuses on patients and their adherence to at least one statin medication of any intensity during the measurement year.

Service Needed

Patients 40 to 75 years of age with diagnosis of diabetes who do not have diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD) and being treated with and remain taking at least one statin medication of any intensity.

Two rates reported for this measure are:

1. The percentage of patients who are dispensed at least one statin medication of any intensity during the measurement year.
2. Percentage of patients who remain on a statin medication of any intensity for at least 80 percent of the treatment period.

Tips for Attainment:

• At each visit, review the medication list and ask if there are any issues with filling or taking medications as prescribed. If there are any problems/issues with the medication, open-ended questions will assist you with solutions and remove patient barriers to adherence.
• Assess health literacy to determine need for additional support in medication management.
• Educate members on the purpose of taking a statin medication to prevent cardiovascular disease. Discuss how often to take the medication and possible side effects.
• Advise member to contact provider's office if side effects occur or are suspected. Consider an alternative dosing schedule to prevent or lessen side effects.
• Offer 100-day supply of medication to members, if stable.
• Encourage member to sign up for mail orders at their retail or mail-order pharmacy.
• Reminder calls, emails, text messages or mailings can assist with ensuring members do not miss scheduled appointments.
• Schedule an annual visit or follow-up visit before the member leaves the office.
• Ensure member completes any required labs such as cholesterol, kidney values (both blood and urine) and/or A1c.

SUPD: Statin Use in Persons with Diabetes
Product Line: Medicare

Statin Use in Persons with Diabetes is a Medicare measure that is defined as the percent of Medicare Part D beneficiaries ages 40 to 75 who were dispensed at least two diabetes medication fills on unique days of service and received a statin medication fill during the measurement period.

Service Needed

Patients 40 to 75 years of age with diagnosis of diabetes being treated with and remain taking at least one statin medication of any intensity.

The rate reported for this measure is:
The percentage of Medicare Part D beneficiaries ages 40 to 75 who were dispensed at least two diabetes medication fills on unique days of service and received a statin medication fill during the measurement period.

Tips for Attainment:

• At each visit, review the medication list and ask if there are any issues with filling or taking medications as prescribed. If there are any problems/issues with the medication, open-ended questions will assist you with solutions and remove patient barriers to adherence.
• Assess health literacy to determine need for additional support in medication management.
• Educate members on the purpose of taking a statin medication to prevent cardiovascular disease. Discuss how often to take the medication and possible side effects.
• Advise member to contact provider's office if side effects occur or are suspected. Consider an alternative dosing schedule to prevent or lessen side effects.
• Offer 100-day supply of medication to members, if stable.
• Encourage member to sign up for mail orders at their retail or mail-order pharmacy.
• Reminder calls, emails, text messages or mailings can assist with ensuring members do not miss scheduled appointments.
• Schedule an annual visit or follow-up visit before the member leaves the office.
• Ensure member completes any required labs such as cholesterol, kidney values (both blood and urine) and/or A1c.
• Diabetes is an epidemic in the United States. According to the Centers for Disease Control and Prevention (CDC), over 38 million Americans have diabetes and face its devastating consequences. What’s true nationwide is also true in Ohio. Obesity is linked to up to 53 percent of new cases of type 2 diabetes each year. Treating the chronic disease of obesity can help prevent, delay, and even result in diabetes remission. See the great information provided by the AMA below.

AMA - The Burden of Diabetes in OhioExternal Link

For more information, exclusions and improvement tips see our HEDIS Reference Guide (PDF).