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Use of Opioids from Multiple Providers in Persons Without Cancer

CBE ID
2950
Endorsed
Endorsement Status
1.1 New or Maintenance
E&M Cycle
Is Under Review
No
Next Planned Maintenance Review
Patient Safety Spring 2024
1.3 Measure Description

The proportion (XX out of 1,000) of individuals without cancer receiving prescriptions for opioids from four (4) or more prescribers AND four (4) or more pharmacies.

        • 1.14 Numerator

          Any member in the denominator who received opioid prescription claims from 4 or more prescribers AND 4 or more pharmacies.

        • 1.15 Denominator

          Any member with two or more prescription claims for opioids filled on at least two separate days, for which the sum of the days supply is greater than or equal to 15.

        • Exclusions

          Any member with a diagnosis for Cancer or a Prescription Drug Hierarchical Condition Category (RxHCC) 8, 9, 10, or 11 for Payment Year 2015; or RxHCC 15, 16, 17, 18, or 19 for Payment Year 2016; (see list in S.11 and S.2b); or a hospice indicator from the enrollment database.

        • 1.13a Data dictionary not attached
          No
        • Most Recent Endorsement Activity
          Endorsed Patient Safety Project 2015-2017, Phase 3
          Initial Endorsement
          Last Updated
              • Risk adjustment approach
                Off
                Risk adjustment approach
                Off
                Conceptual model for risk adjustment
                Off
                Conceptual model for risk adjustment
                Off