​In CMS156v5, we were unable to separate medications therefore the guidance included instructions for Numerator 2. The intent of Numerator 2 was that if the patient was prescribed 2 different high risk medications, they would be a numerator hit. In your example, based on the guidance, that patient wouldn't meet numerator criteria.

If a high-risk medication is ordered and refilled in the measure period, would that push a provider into the 2+ medications numerator? The text of the measure clearly states "Percentage of patients who were ordered at least two different high-risk medications" but I don't see in the measure definition how this is expressed - I.E count >= 2 I see, but no way of expressing distinctness.