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Pharmacotherapy Management of COPD Exacerbation (PCE)

Based on current NCQA HEDIS recommendations, your TO-DO LIST for members 40 years of age or older should include:

  • A dispensed prescription for systemic corticosteroid on or 14 days after the Episode Date.
    Or
  • A dispensed prescription for a bronchodilator on or 30 days after the Episode Date.

Why should you complete your TO-DO LIST?

It is an evidence-based, best practice and these actions are used to measure your quality performance.

HEDIS Pharmacotherapy Management of COPD Exacerbation (PCE) Definition:

(NCQA HEDIS guidelines, Measurement Year (MY) 2020 & MY 2021)

  • The percentage of COPD exacerbations for members 40 years of age and older who had an acute inpatient discharge or ED visit on or between January 1 - November 30 of the measurement year and who were dispensed appropriate medications. Two rates are reported:
    1. Dispensed a systemic corticosteroid (or there was evidence of an active prescription) within 14 days of the event.
    2. Dispensed a bronchodilator (or there was evidence of an active prescription) within 30 days of the event.
  • Line of Business: Commercial, Medicaid, Medicare

Requirement:

Systemic corticosteroid: Dispensed prescription for systemic corticosteroid (SystemicCorticosteroidMedicationsList) on or 14 days after the Episode Date. Count systemic corticosteroids that are active on the relevant date.

Bronchodilator: Dispensed prescription for a bronchodilator (BronchodilatorMedicationsList) on or 30 days after the Episode Date. Count bronchodilators that are active on the relevant date.

Systemic Corticosteroid Medications

Description: Prescription
Glucocorticoids
  • Cortisone-acetate
  • Dexamethasone
  • Hydrocortisone
  • Methylprednisolone
  • Prednisolone
  • Prednisone

Bronchodilator Medications

Description: Prescription
Anticholinergic agents
  • Aclidinium-bromide
  • Ipratropium
  • Tiotropium
  • Umeclidinium
Beta 2-agonists
  • Albuterol
  • Arformoterol
  • Formoterol
  • Indacaterol
  • Levalbuterol
  • Metaproterenol
  • Salmetero
Bronchodilator combinations
  • Albuterol-ipratropium
  • Budesonide-formoterol
  • Dyphylline-guaifenesin
  • Fluticasone-salmeterol
  • Fluticasone-vilanterol
  • Fluticasone furoate-umeclidinium-vilanterol
  • Formoterol-aclidinium
  • Formoterol-glycopyrrolate
  • Formoterol-mometasone
  • Indacaterol-glycopyrrolate
  • Olodaterol hydrochloride
  • Olodaterol-tiotropium
  • Umeclidinium-vilanterol

To learn more about your practice’s current HEDIS performance for this or other measures, or for assistance in compliance with the HEDIS guidelines, please call 1-844-754-2451.

Reference: NCQA HEDIS Measurement Year (MY) 2020 & MY 2021 Technical Specs CPT® is a registered trademark of the American Medical Association.