Eliquis not qualifying as an anticoagulant in the value sets for CMS71

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Karen McLaughlin
    • 667-217-6550
    • Medisolv, Inc.
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      Thank you for your question regarding the medication value sets and the use of generic form of the medications for measures CMS104v13, CMS71v14, and CMS72v13. The medication value sets developed for the program contain RXNORM codes that are Semantic Clinical Drugs (SCD), generic, and prescribable.

      The RXNORM code 1364447 is a semantic branded drug (SBD) and can be mapped to the equivalent SCD 1364445.

      CMS108v13/190v13 value set Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment 2.16.840.1.113883.3.117.1.7.1.134 does not include the SBD RXNORM code 1364447 but does include the SCD equivalent 1364445.

      CMS71v14 value set Anticoagulant Therapy value set 2.16.840.1.113883.3.117.1.7.1.200 and CMS104v13/CMS72v13 value set Antithrombotic Therapy for Ischemic Stroke value set 2.16.840.1.113762.1.4.1110.62 includes the SCD equivalent 1364445.

      You may need to verify with your vendor or IT staff when a branded drug product is ordered that it is appropriately mapped to the SCD within the value set.
      Show
      Thank you for your question regarding the medication value sets and the use of generic form of the medications for measures CMS104v13, CMS71v14, and CMS72v13. The medication value sets developed for the program contain RXNORM codes that are Semantic Clinical Drugs (SCD), generic, and prescribable. The RXNORM code 1364447 is a semantic branded drug (SBD) and can be mapped to the equivalent SCD 1364445. CMS108v13/190v13 value set Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment 2.16.840.1.113883.3.117.1.7.1.134 does not include the SBD RXNORM code 1364447 but does include the SCD equivalent 1364445. CMS71v14 value set Anticoagulant Therapy value set 2.16.840.1.113883.3.117.1.7.1.200 and CMS104v13/CMS72v13 value set Antithrombotic Therapy for Ischemic Stroke value set 2.16.840.1.113762.1.4.1110.62 includes the SCD equivalent 1364445. You may need to verify with your vendor or IT staff when a branded drug product is ordered that it is appropriately mapped to the SCD within the value set.
    • CMS0071v14, CMS0072v13, CMS0104v13
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      Eliquis is the brand name for apixaban and is used both as an antithrombotic and anticoagulant. It is only in the value set for Oral Xa Inhibitor for CMS108 and CMS190. It is not in the value set for CMS71. The only RxNorm code in the value set for this drug is apixaban (the generic name). Both need to be included.
      Show
      Eliquis is the brand name for apixaban and is used both as an antithrombotic and anticoagulant. It is only in the value set for Oral Xa Inhibitor for CMS108 and CMS190. It is not in the value set for CMS71. The only RxNorm code in the value set for this drug is apixaban (the generic name). Both need to be included.

      In the current value sets, Eliquis is in the value set for CMS108 and CMS190. This RxNorm code is 1364447 and is listed as apixaban 5 mg oral tablet - Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment. The same drug with RxNorm code 1364445 is listed for both VTE measures and Stroke measures - apixiban 5 mg Oral Tablet. The formulary vendors map Eliquis to 1364447 and apixiban to 1364445. Hospital use formulary vendors to map their medications accurately. Why does CMS not recognize the RxNorm code 1364447 for stroke measures when it is the same drug (just the Brand Name version). There is documentation from the drug companies that state this drug is used for both an antithrombotic and an anticoagulant. We have patients falling out of the stroke measure erroneously because of providers writing prescriptions for Eliquis instead of apixaban. 

            Assignee:
            Augustine Weber
            Reporter:
            Karen McLaughlin (Inactive)
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