This measure identifies adults with migraines who are frequently taking acute (abortive) medications and are also taking a prophylactic medication for migraine control.
Measure Specs
General Information
Numerator
If YES to any of the following: 9, or 12, or 15, or 18 where:
9 states: Did the patient fill a prescription for an anticonvulsant (code set RX-12) during the following time period: last 120 days of the report period through 90 days after the end of the report period?
12 states: Did the patient fill a prescription for a Beta-Blocker-containing medication (code set RX-23) during the following time period: last 120 days of the report period through 90 days after the end of the report period?
15 states: Did the patient fill a prescription for a Calcium Channel Blocker-containing medication (code set RX-31) during the following time period: last 120 days of the report period through 90 days after the end of the report period?
18 states: Did the patient fill a prescription for a tricyclic antidepressant (code set RX-119) during the following time period: last 120 days of the report period through 90 days after the end of the report period?
Time Window:120 days prior to the end of the report period through 90 days after the end of the report period
Denominator
See attached "Migraine ebm Alg" document for member demographics, member enrollment, and condition confirmation criteria for denominator migraine definition. In addition, for this measure, the patient must be 18 years of age or older at the end of the report period and must meet the following criteria:
Identify patients with frequent headache, as defined in Appendix 1
Are any of the following equal to YES: 1,2,3,4,5,6,7
1: Was the sum of the Equivalent Doses (EqDose) for triptan (oral only) (code set RX-122) greater than a Threshold of 36 tablets, during the following time period: last 120 days of the report period? EqDose is a defined determination function. Note: Exclude the last claim within this time period.
2: Was the sum of the Equivalent Doses (EqDose) for triptan (subcutaneous only) (code set RX-123) greater than a Threshold of 12 dose equivalents, during the following time period: last 120 days of the report period? Note: Exclude the last claim within this time period.
3: Was the sum of the Equivalent Doses (EqDose) for triptan (nasal only) (code set RX-121) greater than a Threshold of 24 spray bottles, during the following time period: last 120 days of the report period? Note: Exclude the last claim within this time period.
4: Was the sum of the Equivalent Doses (EqDose) for Butorphanol Tartrate (nasal only) (code set RX-29) greater than a Threshold of 10 ml, during the following time period: last 120 days of the report period? Note: Exclude the last claim within this time period.
5: During the following time period: last 120 days of the report period
Was the sum of the Equivalent Doses (EqDose) for Dihydroergotamine Mesylate (nasal only) (code set RX-42) greater than a Threshold of 12 ml?
OR
Was the sum of the Equivalent Doses (EqDose) for dihydroergotamine mesylate (injection only) (code set RX-174) greater than a Threshold of 25 ml? Calculate EqDose for pharmacy claims.
6: Was the sum of the Equivalent Doses (EqDose) for butalbital containing medication (code set RX-28) greater than a Threshold of 100 tablets/capsules, during the following time period: last 120 days of the report period? Note: Exclude the last claim within this time period.
7: Was the sum of the Equivalent Doses (EqDose) for midrin type medication (code set RX-76) greater than a Threshold of 150 capsules, during the following time period: last 120 days of the report period? Note: Exclude the last claim within this time period.
Time Window: 120 days prior to the end of the report period for identification of frequent medication use (Note: migraine condition confirmation requires a time period of up to 24 months or use of a disease registry)
Exclusions
Patients were excluded from this measure if they were less than 18 years of age at the end of the report period since there is insufficient data in this population to recommend prophylactic therapy.
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