Statin use for diabetes and cardiovascular diagnoses

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.

MeasureStatin therapy for cardiovascular diseaseStatin use in persons with diabetes
DescriptionAssesses 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 improvementThose 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 ResourcesReporting 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 therapyModerate-intensity statin therapyLow-intensity statin therapy
Daily dose lowers LDL-C by > 50%, on averageDaily dose lowers LDL-C by 3050%, on averageDaily 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:

  • A different statin medication.
  • A coenzyme (CoQ10) supplement.
  • Alternate-day dosing.
  • Increased water intake.
  • Vitamin D supplementation, if deficient.

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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