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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

June 2017

Prescribing Statins to Members with Diabetes

Based on clinical guidelines and quality measures from the American College of Cardiology/American Heart Association (ACC/AHA) and the Centers for Medicare and Medicaid Services (CMS), Harvard Pilgrim urges providers to prescribe statins to manage cardiovascular risk in their patients with diabetes.

ACC/AHA guidelines recommend statin therapy for primary prevention of cardiovascular events for patients 40-75 years of age with diabetes, regardless of cholesterol levels. The risk for a first myocardial infarction in a patient with diabetes has been shown to be as high as the risk for a new myocardial infarction in a non-diabetic patient who has had a prior myocardial infarction. For this reason, Harvard Pilgrim recommends statin therapy to reduce the risk of cardiovascular events in nearly all patients age 40 or older with diabetes.

Additionally, CMS has identified statin use in patients with diabetes as a potential gap in care, and has incorporated it as an area of focus in the Five-Star Quality Rating System — which concentrates on Medicare Advantage plans, such as Harvard Pilgrim’s StrideSM (HMO) plan.  Statin Use in Persons with Diabetes (SUPD) is a display measure for 2018, and will be added as a Star Ratings measure for 2019 (the rating would be calculated from 2017 prescription data).

To further support our members, Harvard Pilgrim has a related quality assurance program in place, in collaboration with MedImpact, which is designed to promote high-quality and cost-effective drug therapy for our members. The program is run on a quarterly basis and identifies patients with diabetes who were not receiving a statin drug during the previous three-month period.

Harvard Pilgrim sends letters to the providers of identified members, which include the medication profiles of the identified members. If you receive one of these letters, please review the patient’s medical record to determine whether or not statin therapy would be appropriate, and if so, take steps to update the patient’s medication regimen accordingly.

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Network Matters Archives

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Changes to Sleep Diagnostic and Sleep Therapy Program

Review of Inpatient Admissions for Appropriate Level of Care

Reminder: Concurrent Review for Inpatient Stays

New Publication on Healthy Eating for Older Adults


Reminder: Expanded Medical Drug Prior Authorization Program

ACA Risk Adjustment Data Validation Reminder: Medical Chart Requests

Update to StrideSM (HMO) Medicare Advantage Hysterectomy Criteria

Updates to Bariatric Surgeries Medical Review Criteria

Updates to Varicose Vein Procedures Medical Review Criteria

Update to Cardiac Event Monitors Medical Policy

Prescribing Statins to Members with Diabetes

Members’ Rights and Responsibilities

Biological Effects of Cannabis and Detriments to Adolescent Development


Telemedicine/Telehealth Payment Policy

Change in Format of Newly Assigned Practitioner and Provider ID Numbers

Credentialing Reminder: Keep Provider Information Up to Date in CAQH

Keep Panel Status and Demographic Information Up to Date


Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator