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Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA)

HEDIS Measure

Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA)

Line of business: Commercial Medicaid Medicare

Data Collection Method: Administrative (Claims)

Measure Description

The percentage of members 18 years of age and older during the measurement year with schizophrenia or schizoaffective disorder who were dispensed and remained on an antipsychotic medication for at least 80% of their treatment period.

Numerator Compliance

Members who achieved a PDC of at least 80% for their antipsychotic medications during the measurement year.

IPSD - Index prescription start date. The earliest prescription dispensing date for any antipsychotic medication during the measurement year.

Treatment period - The period of time beginning on the IPSD through the last day of the measurement year.

PDC = Proportion of days covered. The number of days a member is covered by at least one antipsychotic medication prescription, divided by the number of days in the treatment period.

Best Practices

  • Educate patients and their caregivers on the importance of medication compliance
  • Discuss with members potential medication side-effects and when to call their provider
  • Ensure providers maintain appointment availability in your practice for patients and schedule follow-up appointments before patient leaves appointment
  • Reach out to patients that do not keep follow-up appointments and set flags if available in EHR or develop tracking method for patients due or past due for follow-up visits and require staff to follow up with patients that miss or cancel their appointment
  • Coordinate care with patients’ behavioral health specialists
  • Outreach patients who cancel appointments and reschedule them as soon as possible
Oral Antipsychotic Medications
Description Prescription Medication Lists
Miscellaneous antipsychotic agents (oral)
  • Aripiprazole
Aripiprazole Oral Medications List
  • Asenapine
Asenapine Oral Medications List
  • Brexpiprazole
Brexpiprazole Oral Medications List
  • Cariprazine
Cariprazine Oral Medications List
  • Clozapine
Clozapine Oral Medications List
  • Haloperidol
Haloperidol Oral Medications List
  • Iloperidone
Iloperidone Oral Medications List
  • Loxapine
Loxapine Oral Medications List
  • Lumateperone
Lumateperone Oral Medications List
  • Lurasidone
Lurasidone Oral Medications List
  • Molindone
Molindone Oral Medications List
  • Olanzapine
Olanzapine Oral Medications List
  • Paliperidone
Paliperidone Oral Medications List
  • Quetiapine
Quetiapine Oral Medications List
  • Risperidone
Risperidone Oral Medications List
  • Ziprasidone
Ziprasidone Oral Medications List
Phenothiazine antipsychotics (oral)
  • Chlorpromazine
Chlorpromazine Oral Medications List
  • Fluphenazine
Fluphenazine Oral Medications List
  • Perphenazine
Perphenazine Oral Medications List
  • Prochlorperazine
Prochlorperazine Oral Medications List
  • Thioridazine
Thioridazine Oral Medications List
  • Trifluoperazine
Trifluoperazine Oral Medications List
Psychotherapeutic combinations (oral)
  • Amitriptyline-perphenazine
Amitriptyline Perphenazine Oral Medications List
Thioxanthenes (oral)
  • Thiothixene
Thiothixene Oral Medications List
Long-Acting Injections
Description Prescription Medication Lists
Long-acting injections 14 days supply
  • Risperidone (excluding Perseris®)
Long Acting Injections 14 Days Supply Medications List
Long-acting injections 28 days supply
  • Aripiprazole
  • Haloperidol decanoate
Long Acting Injections 28 Days Supply Medications List
  • Aripiprazole lauroxil
  • Olanzapine
  • Fluphenazine decanoate
  • Paliperidone palmitate
Long-acting injections 30 days supply
  • Risperidone (Perseris®)
Long Acting Injections 30 Days Supply Medications List

Quality Value Set Directory Coding Tips

Long Acting Injections 14 Days Supply


  • J2794

Long Acting Injections 28 Days Supply


  • J0401
  • J1631
  • J1943
  • J1944
  • J2358
  • J2426
  • J2680

Long Acting Injections 30 Days Supply


  • J2798