URSA-PHARM-001: Outpatient Pharmacy PMPM Plan Spending

  • Published on Apr 10, 2026
  • 43 minute(s) read
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Measure Description

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

Metadata

  • Measure Identifier: URSA-PHARM-001
  • 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 -- The internal database identifier (used, e.g., for joins and primary keys) for the patient. This value is typically mastered, i.e., all records for the same patient, regardless of the source data system from which that record originated, should have the same Patient ID value. (Note that while the mastered Patient ID value might resemble a local identifier used in one of the upstream data sources, this does not indicate any special priority of that source system in determining the characteristics of the patient.) (See also [URSA-CORE] Patient)
    • Primary Payor ID -- The internal database identifier (used, e.g., for joins and primary keys) for the Primary Payor. (See also [URSA-CORE] Primary Payor)
    • Primary Plan ID -- The identifier for the health insurance plan product that is the first party responsible for payment.
    • Primary Plan Attributee Provider ID
    • Empirical Attributee Primary Care Individual Provider ID
    • Empirical Attributee Primary Care Provider Group Provider ID
    • Document ID -- The internal database identifier (used, e.g., for joins and primary keys) for the document. (See also [URSA-CORE] Document)
    • Filling Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the filling provider.
    • Prescribing Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the prescribing provider. (See also [URSA-CORE] Prescribing Provider)
    • Lifetime Medication Treatment Episode ID -- The internal database identifier (used, e.g., for joins and primary keys) for the Lifetime Medication Treatment Episode. (See also [URSA-PHARM] Lifetime Medication Treatment Episode)

  • Operations Support Fields

    • Patient Operational ID -- The user-facing value used by staff used to uniquely identify the Patient in their administrative systems and/or day-to-day operations. (See also [URSA-CORE] Patient)
    • Primary Payor Operational ID
    • Primary Plan Operational ID
    • Prescription Number -- The unique, user-facing (“real-world”) identifier used by operational systems or staff to identify the medication order. (See also [URSA-CORE] Medication Order)

  • Patient Fields

    • Patient Date of Birth -- The patient's date of birth. On the Patients Natural Object, this field reflects the "best" known value for the patient available from all data sources; on other Natural Objects, e.g., MMR Member-Months, the value faithfully reflects the date of birth found on that particular type of record in the source data.
    • Patient Age Integer -- Patient age, expressed as an integer, as of a reference date or interval.
    • Patient Age Category Tier 1 -- Non-overlapping ranges of the patient age in years into three categories; [01] Pediatrics < 19, [02] Adults 19 - 64, and [03] Older Adults >= 65. Coarser grain to the Patient Age Category Tier 2. (See also [URSA-CORE] Patient Age Category Tier 2)
    • Patient Age Category Tier 2 -- Non-overlapping ranges of the patient age in years representing finer grain categories than the Patient Age Category Tier 1. This field incorporates findings from publications on defining meaningful age groups in the context of disease. These ranges closely, but not exactly, align with standard age ranges such as those defined by the Medical Subject Headings (MeSH). See results of K-Means simple clustering method at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825015/ (See also [URSA-CORE] Patient Age Category Tier 1)
    • Patient Sex Category
    • Is Patient Sex Female -- Indicates the patient's sex is female. On the Patients Natural Object, this field reflects the "best" known value for the patient available from all data sources; on other Natural Objects, e.g., MMR Member-Months, the value faithfully reflects the patient sex documented on that particular type of record in the source data.
    • Is Patient Sex Male -- Indicates the patient's sex is male. On the Patients Natural Object, this field reflects the "best" known value for the patient available from all data sources; on other Natural Objects, e.g., MMR Member-Months, the value faithfully reflects the patient sex documented on that particular type of record in the source data.
    • 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 -- The start date of the Continuous Primary Payor Membership Episode in effect as of the (potentially historical) period covered by the record. (See also [URSA-CORE] Continuous Primary Payor Membership Episode)
    • Current Continuous Primary Payor Membership Episode End Date -- The end date of the Continuous Primary Payor Membership Episode in effect as of the (potentially historical) period covered by the record. Values follow the standard exclusive convention for Period End Dates. (See also [URSA-CORE] Continuous Primary Payor Membership Episode, [URSA-CORE] Period End Date)
    • Current Continuous Pharmacy Claim Data Coverage Episode Start Date -- The start date of the Continuous Pharmacy Claim Data Coverage Episode in effect as of the (potentially historical) period covered by the record. (See also [URSA-CORE] Continuous Pharmacy Claim Data Coverage Episode)
    • Current Continuous Pharmacy Claim Data Coverage Episode End Date -- The end date of the Continuous Pharmacy Claim Data Coverage Episode in effect as of the (potentially historical) period covered by the record. Values follow the standard exclusive convention for Period End Dates. (See also [URSA-CORE] Continuous Pharmacy Claim Data Coverage Episode)
    • Filled Date -- The date a prescription or medication order was filled, with medications dispensed.
    • 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 -- The 10-digit National Provider Identifier for the prescribing provider. (See also [URSA-CORE] Prescribing Provider)
    • Filling Provider NPI -- The 10-digit National Provider Identifier for the filling provider. (See also [URSA-CORE] Filling Provider)
    • 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.
    • Is Filling Provider Mail Order Pharmacy -- Indicates the filling provider is a mail-order pharmacy. (See also [URSA-CORE] Filling Provider)
    • Filling Provider Description -- The natural language description of the filling provider. (See also [URSA-CORE] Filling Provider)
    • Filling Provider Primary NUCC Provider Taxonomy Code -- The primary NUCC Provider Taxonomy code for the filling provider. (See also [URSA-CORE] Filling Provider, [URSA-CORE] Primary NUCC Provider Taxonomy Code)
    • Filling Provider Primary NUCC Provider Taxonomy Description -- The primary NUCC Provider Taxonomy description for the filling provider. (See also [URSA-CORE] Filling Provider, [URSA-CORE] 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 -- A value between 1 and 100 representing the composite measure of socioeconomic deprivation from University of Wisconsin’s School of Medicine and Public Health. Scores are for Census Block Group geographic level, which generally contains between 600 and 3,000 people. Higher scores indicate more deprivation, so a score of 1 indicates the least deprivation while a score of 100 indicates the most deprivation. Percentiles are constructed by ranking the ADI from low to high for the nation and grouping the block groups into bins corresponding to each 1% range of the ADI. The 2019 ADI was constructed using the 2015-2019 5-year estimates from the US Census' American Community Survey and includes 17 component measures that span the domains of income, education, employment, and housing quality. It may be linked with the 9-digit ZIP code crosswalk, which was built to correspond directly to Census block groups. The 2019 ADI was released on 07/14/2021 and is the most recent version as of 02/02/22.
    • UW HIP ADI Quintile Category -- The UW HIP Area Deprivation Index National Percentile grouped into 5 levels, each spanning 20 percentile points (ADI 1 is percentile scores from 1 to 20 while ADI 5 is scores from 81 to 100). Higher scores indicate more deprivation, so ADI 1 is the least deprived while ADI 5 is the most deprived. Quintiles are frequently used in health research. They give larger sample sizes per group and are easier to plot and interpret. Quintiles also carry less information and group more dissimilar patients. Quintiles are good for descriptive analyses while the original percentile measure is preferable for predictive modeling. (See also [URSA-CORE] UW HIP Area Deprivation Index National Percentile)
    • CDC SVI Overall Quintile Category -- The CDC SVI Overall National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable. Quintiles are frequently used in health research. They give larger sample sizes per group and are easier to plot and interpret. Quintiles also carry less information and group more dissimilar patients. Quintiles are good for descriptive analyses while the original percentile measure is preferable for predictive modeling.
    • CDC SVI Socioeconomic Theme National Percentile -- Includes the five Census measures of (1) Percent below 150% poverty, (2) Unemployment rate, (3) Per-capita income, and (4) Percent with no high school diploma, (5) percent uninsured. Follows the same methodology as the overall SVI composite. (See also [URSA-CORE] CDC SVI Socioeconomic Quintile Category, [URSA-CORE] CDC SVI Overall National Percentile)
    • CDC SVI Socioeconomic Quintile Category -- The CDC SVI Socioeconomic Theme National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable. (See also [URSA-CORE] CDC SVI Socioeconomic Theme National Percentile )
    • CDC SVI Household / Disability Theme National Percentile -- Includes the four Census measures of (1) Percent aged 65 or older (2) Percent aged 17 or younger, (3) Percent with a disability (noninstitutionalized and older than age 5), and (4) Percent single parent households. Follows the same methodology as the overall SVI composite. (See also [URSA-CORE] CDC SVI Household / Disability Quintile Category, [URSA-CORE] CDC SVI Overall National Percentile)
    • CDC SVI Household / Disability Quintile Category -- The CDC SVI Household/Disability Theme National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable. (See also [URSA-CORE] CDC SVI Household / Disability Theme National Percentile )
    • CDC SVI Minority / Language Theme National Percentile -- Includes the two Census measures of (1) Percent minority (all persons except white, non-Hispanic), (2) Percent who speak English "less than well" (persons age 5+). Follows the same methodology as the overall SVI composite. (See also [URSA-CORE] CDC SVI Minority / Language Quintile Category, [URSA-CORE] CDC SVI Overall National Percentile)
    • CDC SVI Minority / Language Quintile Category -- The CDC SVI Minority/Language Theme National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable. (See also [URSA-CORE] CDC SVI Minority / Language Theme National Percentile)
    • CDC SVI Housing / Transportation Theme National Percentile -- Includes the five Census measures of (1) Percent housing structures with 10 or more units, (2) Percent mobile homes, (3) Percent households with more people than rooms, (4) Percent households with no vehicle available, (5) Percent living in group quarters (such as correctional facilities, nursing homes, college dorms, and military barracks). Follows the same methodology as the overall SVI composite. (See also [URSA-CORE] CDC SVI Housing / Transportation Quintile Category, [URSA-CORE] CDC SVI Overall National Percentile)
    • CDC SVI Housing / Transportation Quintile Category -- The CDC SVI Housing/Transportation Theme National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable. (See also [URSA-CORE] CDC SVI Housing / Transportation Theme National Percentile)

  • 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 -- Indicates the patient meets the Medicare ESRD eligibility criterion as of a particular date; can be derived from the CMS Medicare Beneficiary Status Code. (See also [URSA-CORE] CMS Medicare Beneficiary Status Code)
    • Is CMS Hospice Status -- Indicates the patient is considered to be Hospice status.
    • Count Active Plan Memberships
    • Is Dual Medicare-Medicaid Enrolled -- Indicates that the patient is concurrently enrolled in both Medicare and Medicaid programs. (Identifies the population often described as "dually eligible" or "duals".)

  • 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 -- The standard 11-digit National Drug Code; e.g., 00045012400 = Tylenol 500 mg.
    • Label Description -- Supplies the name given to the product by the manufacturer.
    • Is OTC -- Indicates that the medication is an over-the-counter (OTC) drug that does not require a prescription.
    • Red Book Generic Cross Reference Code -- A unique 6-digit code assigned to all products that contain the same set of active ingredients. By extracting all records containing this code, users can identify comparable products regardless of trade or generic name. (See also [URSA-CORE] Red Book Generic Formulation Code)
    • Active Ingredients Description -- A natural language description of the medication's biologically active ingredient(s). For medications with multiple active ingredients, the active ingredients should be listed in alphabetical order.
    • Red Book Generic Formulation Code -- A unique 6-digit code identifying drugs with common active ingredients, master dosage form, strength, and route of administration. The GFC is not manufacturer or package size specific, and can therefore be used in preparation of drug utilization reports and analysis of generic alternatives for substitution and formulary development. The GFC may also be used within pharmacy and claims administration systems as an efficient means of linking NDC numbers to clinical screening functions. (See also [URSA-CORE] Red Book Generic Cross Reference Code)
    • Primary Agent Description -- The primary active ingredient in the medication. In medications with multiple active ingredients, this identifies by name only the primary agent.
    • Form Description -- The natural language description of the medication's form. (See also [URSA-CORE] Medication Form)
    • Route of Administration Description -- The natural language description of the medication's route of administration.
    • Quantity Dispensed -- The quantity of medication dispensed in the fill. For medications with discrete forms (e.g., tablets, capsules, etc.) this is the number of those discrete units dispensed. For non-discrete forms (e.g., solution, cream, etc.) this is some other measure of quantity, including (but not necessarily) the number of doses dispensed.
    • Days Supply -- The number of calendar days, including the date the medication was dispensed, the dispensed medication will last at the patient's intended dosage as defined in their prescription.
    • Days Supply Category Tier 1 Description
    • Is Single Day Supply
    • Is 30 Days Supply
    • Is 90 Days Supply
    • AHFS Therapeutic Class Code 6-Digit -- The standard 6-digit AHFS Pharmacologic-Therapeutic Class Code, representing the first 3 tiers of the AHFS Pharmacologic-Therapeutic Classification system. The code is expressed as 6 numbers, without special characters delimiting the tiers, with leading and trailing zeros as needed. (See also [URSA-CORE] AHFS Pharmacologic-Therapeutic Classification System)
    • AHFS Therapeutic Class Tier 1 Description -- The natural language description of the first-tier category within the AHFS Therapeutic Classification System that the medication is assigned to. (See also [URSA-CORE] AHFS Pharmacologic-Therapeutic Classification System)
    • AHFS Therapeutic Class Tier 2 Description -- The natural language description of the second-tier category within the AHFS Therapeutic Classification System that the medication is assigned to. (See also [URSA-CORE] AHFS Pharmacologic-Therapeutic Classification System)
    • AHFS Therapeutic Class Tier 3 Description -- The natural language description of the third-tier category within the AHFS Therapeutic Classification System that the medication is assigned to. (See also [URSA-CORE] AHFS Pharmacologic-Therapeutic Classification System)
    • NCPDP Dispense as Written Code -- The standard 1-digit Dispense as Written (DAW) code developed and maintained by the National Council for Prescription Drug Programs (NCPDP), identifying the types of substitutions, if any, the pharmacy can make when filling the prescription; e.g., 1 = Substitution not allowed by prescriber.
    • NDC Count of Fills with Payment Percentile
    • NDC Count of Fills Quintile Category

  • Diagnosis Fields

    • CCW Count Category
    • Count CCW Conditions -- The total of both Chronic Conditions and Potentially Disabling Events included in the CMS Chronic Condition Warehouse (CCW) library. (See also [URSA-CORE] CCW Comorbidity Category, [URSA-CORE] Count Potentially Disabling Events, [URSA-CORE] CMS Chronic Condition Warehouse (CCW), [URSA-CORE] Count Chronic Conditions)
    • Is CCW Asthma -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW CKD -- Indicates that the patient meets the CMS Chronic Condition Warehouse criteria for chronic kidney disease; i.e., 2 or more qualifying outpatient or professional ICD codes in the prior 2 years, or 1 or more non-outpatient institutional claim ICD codes in the prior 2 years.
    • Is CCW COPD and Bronchiectasis -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Depression -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Diabetes -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Heart Failure -- At least 1 inpatient, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Schizophrenia or Other Psychotic Disorders -- At least 1 inpatient OR 2 other nondrug claims of any service type with one ore more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Bipolar Disorder -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Acquired Hypothyroidism -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Acute Myocardial Infarction -- At least 1 inpatient claim with one or more of the DX codes from the corresponding CCW value set as the first or second diagnosis position in the prior 1 year.
    • Is CCW ADHD, Conduct Disorders, and Hyperkinetic Syndrome -- At least 1 inpatient claim OR 2 other non-drug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Alzheimers Disease -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 3 years.
    • Is CCW Alzheimers Disease and Related Disorders or Senile Dementia -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 3 years.
    • Is CCW Anemia -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Anxiety Disorders -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Atrial Fibrillation -- At least 1 inpatient OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set as the first or second diagnosis position in the prior 1 year.
    • Is CCW Autism Spectrum Disorder -- At least 1 inpatient claim OR 2 other non-drug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Benign Prostatic Hyperplasia -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year. Exclusion: If any of the qualifying claims also have an ICD-10 DX of D29.1, then it is excluded.
    • Is CCW Blindness and Visual Impairment -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Breast Cancer -- At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in prior 1 year.
    • Is CCW Cataract -- At least 1 HOP or Carrier claim with one or more of the DX codes from the corresponding CCW value set as the principal diagnosis position in the prior 1 year.
    • Is CCW Cerebral Palsy -- At least 1 inpatient claim OR 2 other non-drug claims of any service type with DX codes over the last 2 years (See also [URSA-CORE] CMS Chronic Condition Warehouse (CCW))
    • Is CCW Colorectal Cancer -- At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Cystic Fibrosis and Other Metabolic Disorder -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Deafness and Hearing Impairment -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Depressive Disorders -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Endometrial Cancer -- At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Epilepsy -- At least 1 inpatient claim OR 2 other non-drug claims of any service type during the two-year period (See also [URSA-CORE] CMS Chronic Condition Warehouse (CCW))
    • Is CCW Fibromyalgia and Chronic Pain and Fatigue -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Glaucoma -- At least 1 Carrier claim with one or more of the DX codes from the corresponding CCW value set as the principal diagnosis position in the prior 1 year.
    • Is CCW Hip or Pelvic Fracture -- At least 1 inpatient or SNF claim with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Hyperlipidemia -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Hypertension -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Intellectual Disability -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Ischemic Heart Disease -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Learning Disability -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Leukemia -- At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Lung Cancer -- At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Migraine and Chronic Headache -- At least 1 inpatient claim OR 2 non-inpatient claims with DX codes within a 2 year period. (See also [URSA-CORE] CMS Chronic Condition Warehouse (CCW))
    • Is CCW Mobility Impairment -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Multiple Sclerosis -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Muscular Dystrophy -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Obesity -- At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Osteoporosis -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Other Developmental Delay -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Personality Disorder -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Pressure or Chronic Ulcer -- At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Prostate Cancer -- At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW PTSD -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW PVD -- At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Rheumatoid Arthritis or Osteoarthritis -- At least 2 inpatient, SNF, HHA, HOP, or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Schizophrenia -- At least 1 inpatient claim OR 2 other non-drug claims of any service type with DX codes at least one day apart in the prior within the 2 year reference period. Qualifying codes can also be found as a subset of those in the CCW "Schizophrenia or Other Psychotic Disorders". (See also [URSA-CORE] Is CCW Schizophrenia or Other Psychotic Disorders)
    • Is CCW Stroke or Transient Ischemic Attack -- At least 1 inpatient OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
      EXCLUSIONS: If any of the qualifying claims have : 800 <= DX Code <=
      804.9, 850 <= DX Code <= 854.1 in any DX position OR DX V57xx as the principal DX Code, then the claim is excluded.
    • CCW Systems Category
    • Count CCW Systems -- The count of distinct systems of the body with one or more active CCW Condition. CCW Systems are as a parent category to the individual CCW Conditions grouping them based primarily on the human body system they impact such as; Behavioral Health, Cancers, Cardiovascular, Cerebrovascular, Endocrine, Genitourinary, Musculoskeletal, and Pulmonary. (See also [URSA-CORE] CMS Chronic Condition Warehouse (CCW))
    • Is CCW System Behavioral Health -- Indicates the patient has one or more of the following CCW conditions; ADHD, Conduct Disorders, and Hyperkinetic Syndrome, Anxiety Disorders, Autism Spectrum Disorder, Bipolar Disorder, Depression, Depressive Disorders, Personality Disorders, PTSD, Schizophrenia, or Schizophrenia and Other Psychotic Disorders.
    • Is CCW System Cardiovascular -- Indicates the patient has one or more of the following CCW conditions; Acute Myocardial Infarction (AMI), Atrial Fibrillation, Heart Failure, Hypertension, Ischemic Heart Disease, or Peripheral Vascular Disease (PVD).
    • Is CCW System Congenital -- Indicates the patient has one or more of the following CCW conditions; Cerebral Palsy, Cystic Fibrosis and Other Metabolic Disorder, Intellectual Disability, Learning Disability, Muscular Dystrophy, or Other Developmental Delays.
    • Is CCW System Endocrine/Metabolic -- Indicates the patient has one or more of the following CCW conditions; Diabetes, Acquired Hypothyroidism, Hyperlipidemia, or Obesity.
    • Is CCW System Genitourinary -- Indicates the patient has one or more of the following CCW conditions; Benign Prostatic Hyperplasia or Chronic Kidney Disease (CKD).
    • Is CCW System Hematologic -- Indicates the patient has one or more of the following CCW conditions; Anemia.
    • Is CCW System Musculoskeletal -- Indicates the patient has one or more of the following CCW conditions; Hip or Pelvic Fracture, Rheumatoid Arthritis or Osteoarthritis, or Osteoporosis.
    • Is CCW System Neurological -- Indicates the patient has one or more of the following CCW conditions; Alzheimer's Disease, Alzheimer's Disease and Related Disorders or Senile Dementia, Stroke or Transient Ischemic Attack, Epilepsy, Migraine and Chronic Headache, Mobility Impairment, Multiple Sclerosis, or Deafness and Hearing Impairment.
    • Is CCW System Oncologic -- Indicates the patient has one or more of the following CCW conditions; Breast Cancer, Colorectal Cancer, Endometrial Cancer, Lung Cancer, Prostate Cancer, or Leukemia.
    • Is CCW System Ophthalmologic -- Indicates the patient has one or more of the following CCW conditions; Cataract, Glaucoma, or Blindness and Visual Impairment.
    • Is CCW System Pulmonary -- Indicates the patient has one or more of the following CCW conditions; Asthma, or Chronic Obstructive Pulmonary Disease (COPD) and Bronchiectasis.
    • Is CCW System Other -- Indicates the patient has one or more of the following CCW conditions; Fibromyalgia and Chronic Pain and Fatigue, Pressure or Chronic Ulcer.

  • 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 -- The amount actually paid by the health plan to the provider for a service or product. Subtracting the plan paid amount from the total due amount typically yields the patient responsibility amount. On billing records, which may identify up to three plans responsible for payment, the Primary Plan Paid Amount, Secondary Plan Paid Amount, and Tertiary Plan Paid Amount fields identify the amounts paid by the primary, secondary, and tertiary plans listed on the bill, respectively; the total paid by any and all plans on a bill is identified by the Any Plan Paid Amount field.
    • Patient Paid Amount -- The amount paid by the patient to the provider for health care services or products.
    • COB Paid Amount -- The total amount paid to the provider by one or more health plans other than the plan identified on the claim record as part of a "coordination of benefit" (COB) action; a COB scenario can arise when a patient has multiple concurrent plan memberships.
    • Is Total Paid >= 1k

  • Metadata Fields

    • Random Integer 1 to 1000

  • Measure Fields

    • Denominator
    • Numerator

  • Module Fields

    • 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 (See also [URSA-PHARM] Is High Number of Chronic Medications, [URSA-PHARM] Is High Medication Spend, [URSA-PHARM] Is Very High Medication Spend, [URSA-PHARM] Is High Number of Filling Providers, [URSA-PHARM] Is High Number of Prescribing Providers, [URSA-PHARM] Is Multiple Opioid Prescribing Providers Last 6 Months, [URSA-PHARM] Is Multiple Opioid Filling Providers Last 6 Months, [URSA-PHARM] Is Active Chronic Opioid Episode)
    • 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. (See also [URSA-PHARM] Is High Medication Spend, [URSA-PHARM] Is Very High Medication Spend, [URSA-PHARM] Is High Number of Filling Providers, [URSA-PHARM] Is High Number of Prescribing Providers, [URSA-PHARM] Is Multiple Opioid Prescribing Providers Last 6 Months, [URSA-PHARM] Is Multiple Opioid Filling Providers Last 6 Months, [URSA-PHARM] Is Active Chronic Opioid Episode, [URSA-PHARM] Is High Number of Chronic Medications, [URSA-PHARM] Medication Management Trigger Category)
    • 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. (See also [URSA-PHARM] Is Patient with Active Medication Management Trigger, [URSA-PHARM] Medication Management Trigger Category)
    • 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. (See also [URSA-PHARM] Medication Management Trigger Category)
    • 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.
    • 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. (See also [URSA-PHARM] Medication Management Trigger Category)
    • 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. (See also [URSA-PHARM] Medication Management Trigger Category)
    • 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. (See also [URSA-PHARM] Medication Management Trigger Category)
    • 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 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. (See also [URSA-PHARM] Chronic Medication, [URSA-PHARM] Targeted Medication Therapy Episode, [URSA-PHARM] 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". (See also [URSA-PHARM] Chronic Medication)
    • 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. (See also [URSA-PHARM] Chronic Medication, [URSA-PHARM] Targeted Medication Therapy Episode)
    • 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. (See also [URSA-PHARM] Is Any Active High Risk Medication Episode, [URSA-PHARM] Count Active High Risk Medication Types)
    • 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. (See also [URSA-PHARM] Count Active High Risk Medication Types, [URSA-PHARM] Is High Risk Medication)
    • 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. (See also [URSA-PHARM] Is Any Active High Risk Medication Episode)
    • Count Active Oral Antiplatelets -- 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. (See also [URSA-PHARM] Is High Risk Medication, [URSA-PHARM] High Risk Medication Category)
    • 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. (See also [URSA-PHARM] Anticoagulant, [URSA-PHARM] Is High Risk Medication, [URSA-PHARM] High Risk Medication Category)
    • Count Active Cardiac Glycosides -- One of the High Risk Medication types; a medication classified as a cardiac glycoside based on the AHFS therapeutic class. (See also [URSA-PHARM] Is High Risk Medication, [URSA-PHARM] High Risk Medication Category)
    • Count Active Opioids -- 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. (See also [URSA-PHARM] Is Active Chronic Opioid Episode)
    • Count Active Oral Hypoglycemics -- One of the High Risk Medication types; a medication classified as a hypoglycemic based on the AHFS therapeutic class. (See also [URSA-PHARM] Is High Risk Medication, [URSA-PHARM] High Risk Medication Category)
    • Count Active Insulins -- 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). (See also [URSA-PHARM] Is High Risk Medication, [URSA-PHARM] High Risk Medication Category)
    • 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. (See also [URSA-PHARM] Is Any Priority Adherence Medication Active)
    • 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. (See also [URSA-PHARM] Antidepressant, [URSA-PHARM] Antineoplastic, [URSA-PHARM] Beta Blocker, [URSA-PHARM] Antidiabetic, [URSA-PHARM] Oral ACEI/ARB, [URSA-PHARM] Statin)
    • Count Active Priority Adherence Medications
    • Count Active Priority Medication Types
    • Count Active Antidepressants -- 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. (See also [URSA-PHARM] Is Priority Adherence Medication)
    • Count Active Antidiabetics -- 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.). (See also [URSA-PHARM] Is Priority Adherence Medication, [URSA-PHARM] Active Priority Adherence Medication Type Category)
    • Count Active Oral Antidiabetics
    • Count Active Antineoplastics -- 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. (See also [URSA-PHARM] Is Priority Adherence Medication, [URSA-PHARM] Active Priority Adherence Medication Type Category)
    • Count Active Beta Blockers -- 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. (See also [URSA-PHARM] Is Priority Adherence Medication)
    • Count Active Oral ACEI/ARBs -- 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. (See also [URSA-PHARM] Is Priority Adherence Medication, [URSA-PHARM] Active Priority Adherence Medication Type Category)
    • Count Active Statins -- 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. (See also [URSA-PHARM] Is Priority Adherence Medication)
    • 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 -- 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. (See also [URSA-PHARM] Chronic Medication, [URSA-CORE] AHFS Therapeutic Class Code 6-Digit, [URSA-CORE] Red Book Generic Cross Reference Code, [URSA-PHARM] Is High Risk Medication)
    • Is 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
    • 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. (See also [URSA-PHARM] Antidepressant, [URSA-PHARM] Antineoplastic, [URSA-PHARM] Antidiabetic, [URSA-PHARM] Beta Blocker, [URSA-PHARM] Oral ACEI/ARB, [URSA-PHARM] Statin)
    • Priority Adherence Medication Category -- 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. (See also [URSA-PHARM] Antidepressant, [URSA-PHARM] Antineoplastic, [URSA-PHARM] Antidiabetic, [URSA-PHARM] Beta Blocker, [URSA-PHARM] Oral ACEI/ARB, [URSA-PHARM] Statin)
    • Is 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. (See also [URSA-PHARM] Is Priority Adherence Medication)
    • Is 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. (See also [URSA-PHARM] Is Priority Adherence Medication, [URSA-PHARM] Active Priority Adherence Medication Type Category)
    • Is 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.). (See also [URSA-PHARM] Is Priority Adherence Medication, [URSA-PHARM] Active Priority Adherence Medication Type Category)
    • 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). (See also [URSA-PHARM] Antidiabetic)
    • Is 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. (See also [URSA-PHARM] Is Priority Adherence Medication, [URSA-PHARM] Active Priority Adherence Medication Type Category)
    • Is 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. (See also [URSA-PHARM] Is Priority Adherence Medication)
    • Is 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. (See also [URSA-PHARM] Is Priority Adherence Medication)
    • 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. (See also [URSA-PHARM] Count Active High Risk Medication Types, [URSA-PHARM] Is Any Active High Risk Medication Episode)
    • 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. (See also [URSA-PHARM] Is High Risk Medication)
    • Is Anticoagulant -- One of the High Risk Medication types; a medication classified as an anticoagulant based on the AHFS therapeutic class. (See also [URSA-PHARM] Is High Risk Medication, [URSA-PHARM] High Risk Medication Category)
    • Is 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. (See also [URSA-PHARM] Is High Risk Medication, [URSA-PHARM] High Risk Medication Category)
    • Is Cardiac Glycosides -- One of the High Risk Medication types; a medication classified as a cardiac glycoside based on the AHFS therapeutic class. (See also [URSA-PHARM] Is High Risk Medication, [URSA-PHARM] High Risk Medication Category)
    • Is Oral Hypoglycemic -- One of the High Risk Medication types; a medication classified as a hypoglycemic based on the AHFS therapeutic class. (See also [URSA-PHARM] Is High Risk Medication, [URSA-PHARM] High Risk Medication Category)
    • Is 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). (See also [URSA-PHARM] Is High Risk Medication, [URSA-PHARM] High Risk Medication Category)
    • Is Opiate Agonists -- 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. (See also [URSA-PHARM] Is Active Chronic Opioid Episode)
    • Is Medication Included in PDC Measures
    • PDC Medication Category
    • Is Sacubitril/Valsartan
    • Is Generic -- Derived from the multi-source code and brand name code from Medi-Span using logic from page 2-19 and 2-20 from the Medi-Span documentation manual. This flag generally indicates that a medication is sold by more than one manufacturer, sold under a generic name, and multiple drug products exist for the GPI. Exceptions to this are multi-source and brand name code combinations of MG, NG, MB, and NB. These are products where only one company manufacturers them, but they are sold under a generic name.
    • 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. (See also [URSA-PHARM] Is Generic)
    • 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]