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). In your example, if a patient was prescribed 2 mg of Glimepiride on 3/27/2024 and 3/31/2025, they would not meet the criteria for Numerator 1a because they are not both during the measurement period timeframe. The medication Glimepiride or any code included in the "Potentially Harmful Sulfonylureas for Older Adults" (2.16.840.1.113883.3.464.1003.1059) value set may be used satisfy numerator 1a requirement. If you have questions about reading the measure specification or understanding data requirements, you may refer to the "Guide for Reading eCQMs" for additional guidance. If you have questions regarding implementing the measure, you may refer to the "Implementation Checklist for eCQM Annual Update" for additional guidance. These resources can be found in the eCQI Resource Center: https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=ecqm-resources&global_measure_group=eCQMs .