Use of Opioids from Multiple Providers and at High Dosage in Persons Without Cancer

CBE ID

2951

Endorsement Status

Endorsement Removed

1.0 New or Maintenance

Maintenance

1.1 Measure Structure

Single Measure

Previous Endorsement Cycle

Fall 2021

Is Under Review

1.6 Measure Description

The proportion (XX out of 1,000) of individuals without cancer receiving prescriptions for opioids with a daily dosage greater than 120mg morphine equivalent dose (MED) for 90 consecutive days or longer, AND who received opioid prescriptions from four (4) or more prescribers AND four (4) or more pharmacies.

Measure Specs

General Information

1.7 Measure Type

Process

1.3 Electronic Clinical Quality Measure (eCQM)

1.8 Level of Analysis

Health Plan

Other

1.9 Care Setting

Other

1.20 Types of Data Sources

Claims Data

Numerator

1.14 Numerator

Any member in the denominator with opioid prescription claims where the MED is greater than 120mg for 90 consecutive days or longer* AND who received opioid prescriptions from 4 or more prescribers AND 4 or more pharmacies.

*MED calculation is included in S.6 Numerator Details

Denominator

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 (Medicare Part D) from the enrollment database.

Measure Record

Most Recent Endorsement Activity

Measure Retired and Endorsement Removed Patient Safety Fall Cycle 2021

Initial Endorsement

2017-01