NCQA’s response: Thank you for your inquiry about CMS156v13 (performance period 2025). Numerator 1a is met if two high-risk medications from the same drug class were ordered on different days during the measurement period, or that the medication was ordered once during the measurement period with at least one refill (to indicate two orders). If the high-risk medications are the same, that would also meet the requirement. The list of high-risk medications from the same drug class meeting Numerator 1a are specified by the CQL definition "Same High Risk Medications Ordered on Different Days" (see below). In your example, if a patient was prescribed a 50 mg of nortriptyline on 1/20/2025 and 10 mg of the same drug class (e.g., both codes included in the value set "Potentially Harmful Antidepressants for Older Adults") on 2/26/2025, they would meet the criteria for Numerator 1. Please reference the measure specification for the most updated list of high-risk medications considered for this measure as well as further details about measure requirements: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS156v13.html . If you need assistance reading an eCQM, please refer to the resources available at eCQI Resource Center, such as "Guide for Reading eCQMs" or "Implementation Checklist eCQM Annual Update": https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=ecqm-resources . Same High Risk Medications Ordered on Different Days "More Than One Order"(["Medication, Order": "Potentially Harmful Antihistamines for Older Adults"]) union "More Than One Order"(["Medication, Order": "Potentially Harmful Antiparkinsonian Agents for Older Adults"]) union "More Than One Order"(["Medication, Order": "Potentially Harmful Gastrointestinal Antispasmodics for Older Adults"]) union "More Than One Order"(["Medication, Order": "Dipyridamole Medications"]) union "More Than One Order"(["Medication, Order": "Guanfacine Medications"]) union "More Than One Order"(["Medication, Order": "Nifedipine Medications"]) union "More Than One Order"(["Medication, Order": "Potentially Harmful Antidepressants for Older Adults"]) union "More Than One Order"(["Medication, Order": "Potentially Harmful Barbiturates for Older Adults"]) union "More Than One Order"(["Medication, Order": "ergoloid mesylates, USP 1 MG Oral Tablet"]) union "More Than One Order"(["Medication, Order": "Meprobamate Medications"]) union "More Than One Order"(["Medication, Order": "Potentially Harmful Estrogens for Older Adults"]) union "More Than One Order"(["Medication, Order": "Potentially Harmful Sulfonylureas for Older Adults"]) union "More Than One Order"(["Medication, Order": "Desiccated Thyroid Medications"]) union "More Than One Order"(["Medication, Order": "Potentially Harmful Nonbenzodiazepine Hypnotics for Older Adults"]) union "More Than One Order"(["Medication, Order": "Potentially Harmful Skeletal Muscle Relaxants for Older Adults"]) union "More Than One Order"(["Medication, Order": "Potentially Harmful Pain Medications for Older Adults"]) union "More Than One Order"(["Medication, Order": "Megestrol Medications"]) union "More Than One Order"(["Medication, Order": "Meperidine Medications"])