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    URSA-PHARM-001: Outpatient Pharmacy PMPM Plan Spending
    • 27 Jun 2025
    • 7 Minutes to read
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    URSA-PHARM-001: Outpatient Pharmacy PMPM Plan Spending

    • Updated on 27 Jun 2025
    • 7 Minutes to read
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    Article summary

    Measure Description

    Among active plan membership periods, the per-member-per-month payor spending on outpatient medication fills

    Metadata

    • Measure Type: Rate Measure
    • Temporal Structure: Interval
    • Component Class: Long-Form
    • Denominator Case Field: Patient ID
    • Target Direction: Down

    Denominator Description

    The elapsed patient-months of active plan membership periods

    Numerator Description

    Total payor spending for outpatient pharmacy claims with covered start date falling within the observation period start and end dates

    Published Fields

    • Data Model Keys

      • Patient ID
      • Primary Payor ID
      • Primary Plan ID
      • Primary Plan Attributee Provider ID
      • Empirical Attributee Primary Care Individual Provider ID
      • Empirical Attributee Primary Care Provider Group Provider ID
      • Document ID
      • Filling Provider ID
      • Prescribing Provider ID
      • Lifetime Medication Treatment Episode ID

    • Operations Support Fields

      • Patient Operational ID
      • Primary Payor Operational ID
      • Primary Plan Operational ID
      • Prescription Number

    • Patient Fields

      • Patient Date of Birth
      • Patient Age Integer
      • Patient Age Category Tier 1
      • Patient Age Category Tier 2
      • Patient Sex Category
      • Is Patient Sex Female
      • Is Patient Sex Male
      • PCP Attribution Category
      • Primary Care Engagement Category
      • Count Primary Care Visits in Last 36 Months
      • Specialty Care Engagement Category
      • Count Specialty Care Office Visits in Last 36 Months
      • Primary or Specialty Care Engagement Category
      • Count Clinician Office Visits in Last 3 Years
      • Count Hospital Inpatient Admissions in Last 12 Months
      • Count ED Visits Without Inpatient Admissions in Last 12 Months

    • Date Fields

      • Current Continuous Primary Payor Membership Episode Start Date
      • Current Continuous Primary Payor Membership Episode End Date
      • Current Continuous Pharmacy Claim Data Coverage Episode Start Date
      • Current Continuous Pharmacy Claim Data Coverage Episode End Date
      • Filled Date
      • Filled Date Year
      • Segment Start Date -- The start date of the reporting segment. (See also [URSA-CORE] Reporting Segment)
      • Segment End Date -- The end date of the reporting segment. (See also [URSA-CORE] Reporting Segment)
      • Segmented Period Start Date
      • Segmented Period End Date

    • Provider Fields

      • Count Distinct Filling Providers Last 12 Months
      • Count Distinct Prescribing Providers Last 12 Months
      • Count Distinct Opioid Prescribing Providers in Last 6 Months
      • Count Distinct Opioid Filling Providers in Last 6 Months
      • Count Distinct Opioid Prescribing Providers in Last 12 Months
      • Count Distinct Opioid Filling Providers in Last 12 Months
      • Empirical Attributee PCP Provider NPI
      • Empirical Attributee PCP Provider Description
      • Empirical Attributee Primary Care Provider Group Provider NPI
      • Empirical Attributee Primary Care Provider Group Provider Description
      • Count Visits with Attributee Individual Primary Care Provider in Last 36 Months
      • Count Visits with Attributee Primary Care Provider Group in Last 36 Months
      • Prescribing Provider NPI
      • Filling Provider NPI
      • Is Filling Provider Specialty Pharmacy
      • Is Filling Provider Mail Order Pharmacy
      • Filling Provider Description
      • Filling Provider Primary NUCC Provider Taxonomy Code
      • Filling Provider Primary NUCC Provider Taxonomy Description
      • Provider Fill Volume Percentile Rank
      • Provider Fill Volume Quintile Category
      • Is Filling Provider Major Chain
      • Filling Provider Major Chain Description
      • Filling Provider State Abbreviation
      • Filling Provider ZIP Code 5-Digit

    • Location Fields

      • Patient State Abbreviation
      • Patient ZIP Code 5-Digit
      • UW HIP Area Deprivation Index National Percentile
      • UW HIP ADI Quintile Category
      • CDC SVI Overall Quintile Category
      • CDC SVI Socioeconomic Theme National Percentile
      • CDC SVI Socioeconomic Quintile Category
      • CDC SVI Household / Disability Theme National Percentile
      • CDC SVI Household / Disability Quintile Category
      • CDC SVI Minority / Language Theme National Percentile
      • CDC SVI Minority / Language Quintile Category
      • CDC SVI Housing / Transportation Theme National Percentile
      • CDC SVI Housing / Transportation Quintile Category

    • Insurance Fields

      • Primary Payor Description
      • Primary Plan Description
      • Primary Plan Financial Class Description
      • Is Primary Plan Financial Class Commercial
      • Is Primary Plan Financial Class Medicare Advantage
      • Is Primary Plan Financial Class Medicaid
      • Is CMS ESRD Status
      • Is CMS Hospice Status
      • Count Active Plan Memberships
      • Is Dual Medicare-Medicaid Enrolled

    • Medication Fields

      • Is Patient with any Active Chronic Medications
      • Count of Fills in Last 12 Months Category
      • Count of Fills Last 12 Months
      • Count Opioid Fills in Last 6 Months
      • Count Opioid Fills in Last 12 Months
      • Aggregate Opioid Days Supply in Last 6 Months
      • Aggregate Opioid Days Supply in Last 12 Months
      • NDC Code 11-Digit
      • Label Description
      • Is OTC
      • Red Book Generic Cross Reference Code
      • Active Ingredients Description
      • Red Book Generic Formulation Code
      • Primary Agent Description
      • Form Description
      • Route of Administration Description
      • Quantity Dispensed
      • Days Supply
      • Days Supply Category Tier 1 Description
      • Is Single Day Supply
      • Is 30 Days Supply
      • Is 90 Days Supply
      • AHFS Therapeutic Class Code 6-Digit
      • AHFS Therapeutic Class Tier 1 Description
      • AHFS Therapeutic Class Tier 2 Description
      • AHFS Therapeutic Class Tier 3 Description
      • NCPDP Dispense as Written Code
      • NDC Count of Fills with Payment Percentile
      • NDC Count of Fills Quintile Category

    • Diagnosis Fields

      • CCW Count Category
      • Count CCW Conditions
      • Is CCW Asthma
      • Is CCW CKD
      • Is CCW COPD and Bronchiectasis
      • Is CCW Depression
      • Is CCW Diabetes
      • Is CCW Heart Failure
      • Is CCW Schizophrenia or Other Psychotic Disorders
      • Is CCW Bipolar Disorder
      • Is CCW Acquired Hypothyroidism
      • Is CCW Acute Myocardial Infarction
      • Is CCW ADHD, Conduct Disorders, and Hyperkinetic Syndrome
      • Is CCW Alzheimers Disease
      • Is CCW Alzheimers Disease and Related Disorders or Senile Dementia
      • Is CCW Anemia
      • Is CCW Anxiety Disorders
      • Is CCW Atrial Fibrillation
      • Is CCW Autism Spectrum Disorder
      • Is CCW Benign Prostatic Hyperplasia
      • Is CCW Blindness and Visual Impairment
      • Is CCW Breast Cancer
      • Is CCW Cataract
      • Is CCW Cerebral Palsy
      • Is CCW Colorectal Cancer
      • Is CCW Cystic Fibrosis and Other Metabolic Disorder
      • Is CCW Deafness and Hearing Impairment
      • Is CCW Depressive Disorders
      • Is CCW Endometrial Cancer
      • Is CCW Epilepsy
      • Is CCW Fibromyalgia and Chronic Pain and Fatigue
      • Is CCW Glaucoma
      • Is CCW Hip or Pelvic Fracture
      • Is CCW Hyperlipidemia
      • Is CCW Hypertension
      • Is CCW Intellectual Disability
      • Is CCW Ischemic Heart Disease
      • Is CCW Learning Disability
      • Is CCW Leukemia
      • Is CCW Lung Cancer
      • Is CCW Migraine and Chronic Headache
      • Is CCW Mobility Impairment
      • Is CCW Multiple Sclerosis
      • Is CCW Muscular Dystrophy
      • Is CCW Obesity
      • Is CCW Osteoporosis
      • Is CCW Other Developmental Delay
      • Is CCW Personality Disorder
      • Is CCW Pressure or Chronic Ulcer
      • Is CCW Prostate Cancer
      • Is CCW PTSD
      • Is CCW PVD
      • Is CCW Rheumatoid Arthritis or Osteoarthritis
      • Is CCW Schizophrenia
      • Is CCW Stroke or Transient Ischemic Attack
      • CCW Systems Category
      • Count CCW Systems
      • Is CCW System Behavioral Health
      • Is CCW System Cardiovascular
      • Is CCW System Congenital
      • Is CCW System Endocrine/Metabolic
      • Is CCW System Genitourinary
      • Is CCW System Hematologic
      • Is CCW System Musculoskeletal
      • Is CCW System Neurological
      • Is CCW System Oncologic
      • Is CCW System Ophthalmologic
      • Is CCW System Pulmonary
      • Is CCW System Other

    • Financial Fields

      • Medication Plan Paid Amount in Last 12 Months
      • Medication Patient Paid Amount in Last 12 Months
      • Total Medication Paid Amount Last 12 Months
      • Cumulative Calendar Year Rx Plan Paid Amount
      • Cumulative Calendar Year Rx Patient Paid Amount
      • Total Paid Amount
      • Plan Paid Amount
      • Patient Paid Amount
      • COB Paid Amount
      • Is Total Paid >= 1k

    • Metadata Fields

      • Random Integer 1 to 1000

    • Measure Fields

      • Denominator
      • Numerator

    • Module Fields

      • Medication Management Trigger Category
      • Is Patient with Active Medication Management Trigger
      • Count Active Medication Management Trigger Categories
      • Is High Medication Spend
      • Is Very High Medication Spend
      • Is High Number of Prescribing Providers
      • Is High Number of Filling Providers
      • Is Multiple Opioid Prescribing Providers Last 6 Months
      • Is Multiple Opioid Filling Providers Last 6 Months
      • Is Active Chronic Opioid Episode
      • Is High Number of Chronic Medications
      • Count Active Chronic Medications
      • Active High Risk Medication Episode Category
      • Is Any Active High Risk Medication Episode
      • Count Active High Risk Medication Types
      • Count Active Oral Antiplatelets
      • Count Active Anticoagulants
      • Count Active Cardiac Glycosides
      • Count Active Opioids
      • Count Active Oral Hypoglycemics
      • Count Active Insulins
      • Active Priority Adherence Medication Type Category
      • Is Any Priority Adherence Medication Active
      • Count Active Priority Adherence Medications
      • Count Active Priority Medication Types
      • Count Active Antidepressants
      • Count Active Antidiabetics
      • Count Active Oral Antidiabetics
      • Count Active Antineoplastics
      • Count Active Beta Blockers
      • Count Active Oral ACEI/ARBs
      • Count Active Statins
      • Active PDC Medication Type Category
      • Is Patient with Any Active PDC Medications
      • Count Active PDC Medication Types
      • Is Active Oral Antidiabetic PDC Medication
      • Is Active Oral ACEI/ARB PDC Medication
      • Is Active Statin PDC Medication
      • Is Targeted Medication Type
      • Is Chronic Medication
      • Is Priority Adherence Medication
      • Priority Adherence Medication Category
      • Is Antidepressant
      • Is Antineoplastic
      • Is Antidiabetic
      • Is Oral Antidiabetic
      • Is Oral ACEI/ARB
      • Is Statin
      • Is Beta Blocker
      • Is High Risk Medication
      • High Risk Medication Category
      • Is Anticoagulant
      • Is Oral Antiplatelet
      • Is Cardiac Glycosides
      • Is Oral Hypoglycemic
      • Is Insulin
      • Is Opiate Agonists
      • Is Medication Included in PDC Measures
      • PDC Medication Category
      • Is Sacubitril/Valsartan
      • Is Generic
      • Is Single Source
      • Is CMS Star Measures Oral Antidiabetic
      • Is CMS Star Measures Oral ACEI/ARB
      • Is CMS Star Measures Statin
      • Is CMS Star Measures Sacubitril/Valsartan
      • Is CMS Star Measures Insulin

    • [No Field Group]

      • Ursa Serial ID
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