Ursa Health Pharmacy Module Terms

Active High Risk Medication Episode Category

Categorizes the patient, as of a given date, based on which type(s) of High Risk Medication the patient has an active medication therapy episode for. Patients with more than one type of High Risk Medication type active are categorized as having multiple active types. High Risk Medication Types include; (1) anticoagulant, (2) oral antiplatelet, (3) cardiac glycoside, (4) opiate agonist, (5) oral hypoglycemic, (6) insulin.

Linked Terms: Is Any Active High Risk Medication Episode, Count Active High Risk Medication Types

Active Priority Adherence Medication Type Category

Categorizes the patient, as of a given date, based on which Priority Adherence Medication type(s) are active. Patients with more than one active Priority Adherence Medication types are categorized as having multiple active. Priority Adherence Medications types include; (1) Antidepressant, (2) Antineoplastic, (3) Beta Blocker, (4) Antidiabetics, (5) Oral ACEI/ARB, (6) Statin.

Linked Terms: Is Any Priority Adherence Medication Active

Anticoagulant

One of the High Risk Medication types; a medication classified as an anticoagulant based on the AHFS therapeutic class.

Linked Terms: Is High Risk Medication, High Risk Medication Category

Linked Value Sets: ANTICOAGULANTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT)

Antidepressant

One of the Priority Adherence Medication types; a medication classified as an antidepressant based on AHFS Therapeutic Class code or Red Book Generic Cross Reference Code.

Linked Terms: Is Priority Adherence Medication

Linked Value Sets: ANTIDEPRESSANTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), ANTIDEPRESSANTS (URSA-CORE REDBOOK_GENERIC_CROSS_REFERENCE_CODE)

Antidiabetic

One of the Priority Adherence Medication types; a medication classified as an antidiabetic based on AHFS Therapeutic Class code or Red Book Generic Cross Reference Code as an antidiabetic of any type (insulin, oral, etc.).

Linked Terms: Is Priority Adherence Medication, Active Priority Adherence Medication Type Category

Linked Value Sets: ORAL ANTIDIABETICS (URSA-CORE REDBOOK_GENERIC_CROSS_REFERENCE_CODE), ANTIDIABETICS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT)

Antineoplastic

One of the Priority Adherence Medication types; a medication classified as an antineoplastic based on AHFS Therapeutic Class code. Antineoplastic drugs are medications used to treat cancer. Other names for antineoplastic drugs are anticancer, chemotherapy, chemo, cytotoxic, or hazardous drugs.

Linked Terms: Is Priority Adherence Medication, Active Priority Adherence Medication Type Category

Linked Value Sets: ANTINEOPLASTICS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT)

Beta Blocker

One of the Priority Adherence Medication types; indicates a medication classified as a beta blocker based on the Red Book Generic Cross Reference Code classification.

Linked Terms: Is Priority Adherence Medication

Linked Value Sets: BETA BLOCKERS (URSA-CORE REDBOOK_GENERIC_CROSS_REFERENCE_CODE)

Cardiac Glycosides

One of the High Risk Medication types; a medication classified as a cardiac glycoside based on the AHFS therapeutic class.

Linked Terms: Is High Risk Medication, High Risk Medication Category

Linked Value Sets: CARDIAC GLYCOSIDES (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT)

Chronic Medication

A medication meeting at least one of the following: (1) 3 or more fills over the history of the patient for this or other medications in the same AHFS Therapeutic Class ; (2) 90 or more days supply over the history of the patient for this or other medications in the same AHFS Therapeutic Class

Count Active Anticoagulants

One of the High Risk Medication types; counts, as of a given date, the number of distinct anticoagulants medications the patient has an active medication therapy episode for.

Linked Terms: Anticoagulant, Is High Risk Medication, High Risk Medication Category

Linked Value Sets: ANTICOAGULANTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT)

Count Active Chronic Medications

The number of distinct chronic medications the patient is currently taking; operationalized as the count of targeted medication therapy episodes for a chronic medication currently active for the patient.

Linked Terms: Chronic Medication, Targeted Medication Therapy Episode

Count Active High Risk Medication Types

The number of active medication therapy episodes for high risk medications as defined by the URSA-PHARM module this includes any medication classified as a; anticoagulant, oral antiplatelet, cardiac glycoside, opiate agonist, oral hypoglycemic, or insulin.

Linked Terms: Is Any Active High Risk Medication Episode

Linked Value Sets: ANTICOAGULANTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), ORAL ANTIPLATELET AGENTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), CARDIAC GLYCOSIDES (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), OPIATE AGONISTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), ORAL HYPOGLYCEMIC AGENTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), INSULIN (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT)

Count Active Medication Management Trigger Categories

Indicates that, as of a given date, the count of distinct Medication Management Trigger categories that are active for the patient. Triggers categories include; (1) High Medication Spend, (2) Very High Medication Spend, (3) High Number of Prescribing Providers, (4) High Number of Filling Providers, (5) Multiple Opioid Prescribing Providers Last 6 Months, (6) Multiple Opioid Filling Providers Last 6 Month, (7) Active Chronic Opioid Episode, or (8) High Number of Chronic Medications.

Linked Terms: Is Patient with Active Medication Management Trigger, Medication Management Trigger Category

High Risk Medication Category

Categorical description for medication classified as high risk as defined by the URSA-PHARM module this includes any medication classified as a; anticoagulant, oral antiplatelet, cardiac glycoside, opiate agonist, oral hypoglycemic, or insulin.

Linked Terms: Is High Risk Medication

Linked Value Sets: ANTICOAGULANTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), ORAL ANTIPLATELET AGENTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), CARDIAC GLYCOSIDES (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), OPIATE AGONISTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), ORAL HYPOGLYCEMIC AGENTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), INSULIN (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), INSULIN (URSA-CORE REDBOOK_GENERIC_CROSS_REFERENCE_CODE)

Ingredients Hash

A coded value used to identify all medication fills sharing active ingredients based on the best available data. The Ingredients Hash is primarily based on mapping the NDC to the Red Book Generic Cross Reference Code but, if not found, takes the first non-missing value from (1) the active ingredients listed in the source data, (2) the label description, (3) the NDC code.

Linked Terms: Lifetime Medication Treatment Episode ID, [URSA-CORE] Red Book Generic Cross Reference Code

Insulin

One of the High Risk Medication types; a medication classified as an insulin based on the AHFS therapeutic class or NDC present in the CMS Stars PDC oral anti-diabetic adherence measure specifications (used as an exclusion).

Linked Terms: Is High Risk Medication, High Risk Medication Category

Linked Value Sets: INSULIN (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), CMS STAR INSULIN (URSA-PHARM NDC_CODE_11_DIGIT)

Is Active Chronic Opioid Episode

One of the Medication Management Triggers; indicates that, as of a given date, the patient has an active Medication Therapy Episode for an Opiate Agonist (true = "1") based on the URSA-PHARM value set for Opiate Agonists and logic for classifying fills as Is Chronic.

Linked Terms: Chronic Medication, Targeted Medication Therapy Episode, Medication Management Trigger Category

Linked Value Sets: OPIATE AGONISTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT)

Is Any Active High Risk Medication Episode

Indicates whether the patient, as of a given date, has one or more active medication therapy episodes for High Risk Medication(s) as defined by the URSA-PHARM module. High Risk medications include; anticoagulant, oral antiplatelet, cardiac glycoside, opiate agonist, oral hypoglycemic, or insulin.

Linked Terms: Count Active High Risk Medication Types, Is High Risk Medication

Linked Value Sets: ANTICOAGULANTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), ORAL ANTIPLATELET AGENTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), CARDIAC GLYCOSIDES (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), OPIATE AGONISTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), ORAL HYPOGLYCEMIC AGENTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), INSULIN (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT)

Is Any Priority Adherence Medication Active

Indicates whether the patient, as of a given date, has one or more active Priority Adherence Medication. Priority Adherence Medications types include; (1) Antidepressant, (2) Antineoplastic, (3) Beta Blocker, (4) Antidiabetics, (5) Oral ACEI/ARB, (6) Statin.

Linked Terms: Antidepressant, Antineoplastic, Beta Blocker, Antidiabetic, Oral ACEI/ARB, Statin

Is Filling Provider Specialty Pharmacy

A pharmacy that dispenses generally low volume and high cost medicinal preparations to patients who are undergoing intensive therapies for illnesses that are generally chronic, complex and potentially life threatening. Often these therapies require specialized delivery and administration.

Linked Value Sets: SPECIALTY PHARMACY (URSA-CORE NUCC_PROV_TAXONOMY_CODE)

Is Generic

Derived from available information from first the claims and second Red Book NDC reference data, this flag indicates a medication created to be the same as an already marketed brand-name drug in dosage form, safety, strength, route of administration, quality, performance characteristics, and intended use.

Is High Medication Spend

One of the Medication Management Triggers; indicates that, as of a given date, the total spending on outpatient medication fills for the patient in the prior 12 months is between $4,800 and $9,600, inclusive. Total spending includes both plan and patient paid amounts.

Linked Terms: Medication Management Trigger Category

Is High Number of Chronic Medications

If the patient has 5 or more active medication therapy episodes for chronic medications as of the snapshot date then 1, else 0. This is often referred to as "Polypharmacy".

Linked Terms: Chronic Medication

Is High Number of Filling Providers

One of the Medication Management Triggers; indicates that, as of a given date, the patient has been dispensed outpatient medications from five or more distinct pharmacies or other filling providers in the prior 12 months.

Linked Terms: Medication Management Trigger Category

Is High Number of Prescribing Providers

One of the Medication Management Triggers; indicates that, as of a given date, the patient has filled outpatient medication prescriptions written by five or more distinct prescribing providers in the prior 12 months.

Linked Terms: Medication Management Trigger Category

Is High Risk Medication

Indicates a medication classified as high risk as defined by the URSA-PHARM module this includes any medication classified as a; anticoagulant, oral antiplatelet, cardiac glycoside, opiate agonist, oral hypoglycemic, or insulin.

Linked Terms: Count Active High Risk Medication Types, Is Any Active High Risk Medication Episode

Linked Value Sets: ANTICOAGULANTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), ORAL ANTIPLATELET AGENTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), CARDIAC GLYCOSIDES (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), OPIATE AGONISTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), ORAL HYPOGLYCEMIC AGENTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT), INSULIN (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT)

Is Multiple Opioid Filling Providers Last 6 Months

Indicates (true = "1") if the patient has had fills for opiate agonists from two or more distinct filling providers (pharmacies) in the prior 6 months.

Is Multiple Opioid Prescribing Providers Last 6 Months

One of the Medication Management Triggers; indicates that, as of a given date, the patient has had medication fills for opiate agonists from two or more distinct prescribing providers in the prior 6 months.

Linked Terms: Medication Management Trigger Category

Linked Value Sets: OPIATE AGONISTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT)

Is Oral Antidiabetic

A child to the "Is Antidiabetic" medication type, indicates antidiabetic medications that can be taken orally as opposed other routes of administration (such as injections). Oral Antidiabetics are commonly separated from all antidiabetics for various adherence/quality measures (e.g., Stars PDC).

Linked Terms: Antidiabetic

Linked Value Sets: ORAL ANTIDIABETICS (URSA-CORE REDBOOK_GENERIC_CROSS_REFERENCE_CODE), CMS STAR ORAL ANTIDIABETICS (URSA-PHARM NDC_CODE_11_DIGIT)

Is Patient with Active Medication Management Trigger

Indicates that, as of a given date, the patient has one or more active Medication Management Trigger. Triggers include; (1) High Medication Spend, (2) Very High Medication Spend, (3) High Number of Prescribing Providers, (4) High Number of Filling Providers, (5) Multiple Opioid Prescribing Providers Last 6 Months, (6) Multiple Opioid Filling Providers Last 6 Month, (7) Active Chronic Opioid Episode, or (8) High Number of Chronic Medications.

Linked Terms: Is High Medication Spend, Is Very High Medication Spend, Is High Number of Filling Providers, Is High Number of Prescribing 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, Medication Management Trigger Category

Is Priority Adherence Medication

An URSA-PHARM concept to identify medications commonly targeted for medication adherence measures; indicates the medication is classified as one of the following types; (1) Antidepressant, (2) Antineoplastic, (3) Antidiabetic, (4) Beta Blocker, (5) Oral ACEI/ARB, or (6) Statin.

Linked Terms: Antidepressant, Antineoplastic, Antidiabetic, Beta Blocker, Oral ACEI/ARB, Statin

Is Single Source

Indicates that the medication is considered to be available from only one source, often a brand-name product with no available generic alternatives or a generic for which a single company holds the patent and has sole rights to sell to consumers.

Linked Terms: Is Generic

Is Targeted Medication Type

A medication with a AHFS Therapeutic Class Code or Red Book Generic Cross Reference Code within one or more of the following categories; Chronic, Antidepressant, Antineoplastic, Beta Blocker, Antidiabetic, Oral ACEI/ARB, Statin, Anticoagulant, Oral Antiplatelet, Cardiac Glycoside, Opiate Agonists, Oral Hypoglycemic, or Insulin.

Linked Terms: Chronic Medication, [URSA-CORE] AHFS Therapeutic Class Code 6-Digit, [URSA-CORE] Red Book Generic Cross Reference Code, Is High Risk Medication

Is Very High Medication Spend

One of the Medication Management Triggers; indicates the total spending on outpatient medications for the patient in the prior 12 months is greater than $9,600. Total spending includes both plan and patient paid amounts.

Lifetime Medication Treatment Episode

An episode starting with the patient's first known outpatient fill for a particular medication, defined by active ingredient(s), and extending to include all subsequent fills for medications with the same active ingredient(s) over the patient's life, regardless of the length of time between fills.

Lifetime Medication Treatment Episode ID

The internal database identifier (used, e.g., for joins and primary keys) for the Lifetime Medication Treatment Episode.

Linked Terms: Lifetime Medication Treatment Episode

Medication Management Trigger Category

Category description for grouping patients based on which URSA-PHARM medication management triggers are active as of a given date. Triggers include; (1) High Medication Spend, (2) Very High Medication Spend, (3) High Number of Prescribing Providers, (4) High Number of Filling Providers, (5) Multiple Opioid Prescribing Providers Last 6 Months, (6) Multiple Opioid Filling Providers Last 6 Month, (7) Active Chronic Opioid Episode, or (8) High Number of Chronic Medications

Linked Terms: Is High Number of Chronic Medications, Is High Medication Spend, Is Very High Medication Spend, Is High Number of Filling Providers, Is High Number of Prescribing Providers, Is Multiple Opioid Prescribing Providers Last 6 Months, Is Multiple Opioid Filling Providers Last 6 Months, Is Active Chronic Opioid Episode

Next Medication Synchronization Opportunity Date

Given a Lifetime Medication Treatment Episode as of a particular moment in time this is the earliest of the (1) next fill date for a medication in that episode; or (2) the date the supply from the most recent prior fill for a medication in that episode will be exhausted. That is, either the next fill date or the next supply exhausted date for a particular chronic medication. Because this is the next time the patient may be at the pharmacy to resupply, this represents the next opportunity to align this medication with the patient's other medications (e.g., by dispensing a one-time, smaller-then-usual amount designed to synchronize with the supply of the patient's other chronic medications, eventually resulting in a single date in which all the patient's medications are exhausted simultaneously).

Linked Terms: Lifetime Medication Treatment Episode

Opiate Agonist

One of the High Risk Medication types; a medication classified as an opiate agonist based on the AHFS therapeutic class. Full agonist opioids activate the opioid receptors in the brain fully resulting in the full opioid effect. Examples of full agonists are heroin, oxycodone, methadone, hydrocodone, morphine, opium and others. Partial agonist opioids activate the opioid receptors in the brain, but to a much lesser degree than a full agonist. Buprenorphine is an example of a partial agonist. In clinical practice, they are used for opioid agonist maintenance therapy or withdrawal management.

Linked Terms: Is Active Chronic Opioid Episode

Linked Value Sets: OPIATE AGONISTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT)

Oral ACEI/ARB

One of the Priority Adherence Medication types; indicates a medication classified as a angiotensin-converting enzyme inhibitor (ACEI) and an angiotensin receptor blocker (ARB) based on the Red Book Generic Cross Reference code and/or NDC being included in the CMS Stars measure specifications for Oral ACEI/ARB PDC measures.

Linked Terms: Is Priority Adherence Medication, Active Priority Adherence Medication Type Category

Linked Value Sets: ORAL ACE INHIBITORS / ARBS (URSA-CORE REDBOOK_GENERIC_CROSS_REFERENCE_CODE), CMS STAR ORAL ACEI OR ARB (URSA-PHARM NDC_CODE_11_DIGIT)

Oral Antiplatelet

One of the High Risk Medication types; a medication classified as an oral antiplatelet based on the AHFS therapeutic class or Red Book Generic Cross Reference Code.

Linked Terms: Is High Risk Medication, High Risk Medication Category

Linked Value Sets: ORAL ANTIDIABETICS (URSA-CORE REDBOOK_GENERIC_CROSS_REFERENCE_CODE), ORAL ANTIPLATELET AGENTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT)

Oral Hypoglycemics

One of the High Risk Medication types; a medication classified as a hypoglycemic based on the AHFS therapeutic class.

Linked Terms: Is High Risk Medication, High Risk Medication Category

Linked Value Sets: ORAL HYPOGLYCEMIC AGENTS (URSA-CORE AHFS_THERAPEUTIC_CLASS_CODE_6_DIGIT)

Statin

One of the Priority Adherence Medication types; indicates a medication classified as a Statin based on the Red Book Generic Cross Reference code and/or NDC being included in the CMS Stars Statin proportion of days covered (PDC) measure value sets.

Linked Terms: Is Priority Adherence Medication

Linked Value Sets: STATINS (URSA-CORE REDBOOK_GENERIC_CROSS_REFERENCE_CODE), CMS STAR STATINS (URSA-PHARM NDC_CODE_11_DIGIT)

Targeted Medication Therapy Episode

A continuous period of time during which the patient is in supply, or in a gap of supply fewer than 30 days, for any of the following targeted medication types: antidepressants; antineoplastics; beta blockers; antidiabetics; ACEI/ARBs; statins; high-risk medications (anticoagulants, oral antiplatelets, cardiac glycosides, opiate agonists, oral hypoglycemics, or insulin); or other chronic medications. Medications with the same active ingredients (even if they have different strengths) are considered equivalent for the purpose of constructing these episodes.

Linked Terms: Chronic Medication