April 1, 2024
Cardiovascular disease is the leading cause of death in the United States. The American Diabetes Association and American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend statins for the primary prevention of cardiovascular disease in patients with diabetes, based on age and other risk factors. Guidelines also state that adherence to statins will aid in arteriosclerotic cardiovascular disease (ASCVD) risk reduction in both populations.
Statin therapy clinical performance measures
The Centers for Medicare & Medicaid Services has implemented a Part C and a Part D measure developed by the Pharmacy Quality Alliance and National Committee for Quality Assurance for statin use in patients with cardiovascular disease and statin use in persons with diabetes, respectively.
| Measure | Statin therapy for cardiovascular disease | Statin use in persons with diabetes |
|---|---|---|
| Description | Assesses males aged 21–75 and females aged 40–75 who have clinical ASCVD, and received and adhered to at least one high-intensity or moderate-intensity statin therapy. | Assesses adults aged 40–75 who have diabetes and received at least two diabetes medication fills, and received and adhered to statin therapy. |
| What is needed? | At least one prescription of a moderate-to high-intensity statin in the calendar year. | At least one prescription of any statin in the calendar year. |
| Best practices for improvement | Those who are noncompliant should be outreached to or assessed in-office to determine why they have not filled their prescriptions. | Those who are noncompliant should be outreached to or assessed in-office to determine why they have not filled their prescriptions. |
| Plan Resources | Reporting is available to support patient discussion and compliance. Provider Education and Assessment Tools | Cigna Medicare | |
Statin medications covered by Cigna Healthcare Medicare Advantage
| High-intensity statin therapy | Moderate-intensity statin therapy | Low-intensity statin therapy |
|---|---|---|
| Daily dose lowers LDL-C by > 50%, on average | Daily dose lowers LDL-C by 30–50%, on average | Daily dose lowers LDL-C by < 30%, on average |
| Tier 1: Atorvastatin 40–80 mg QL* Rosuvastatin 20–40 mg QL | Tier 1: Atorvastatin 10–20 mg QL* Simvastatin 20–40 mg QL** Pravastatin 40–80 mg QL Rosuvastatin 5–10 mg QL Lovastatin 40 mg QL Fluvastatin 80 mg QL | Tier 1: Simvastatin 10 mg QL** Pravastatin 10–20 mg QL Lovastatin 20 mg QL Fluvastatin 20–40 mg QL |
When there’s intolerance to a statin medication
If a patient shows intolerance to a statin medication but has no contraindications, consider options such as:
In addition, you may access the ACC’s Statin Intolerance Tool to assess, treat, and manage patients with possible statin intolerance.
Closing medication therapy gaps: Cigna Healthcare resources
We send providers gaps-in-care alerts through the RationalMed® for Cigna Healthcare program, administered by Express Scripts. Additionally, our Medicare Advantage Provider Performance Enablement, Clinical Pharmacy, and Care Management teams collaborate directly with providers to close gaps for statin use in persons with diabetes.
* Including combination products with amlodipine.
** Including combination products with ezetimibe.
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