HEDIS Measure: Use of Opioids at High Dose (OUD) [sic]
For members 18 yrs+, the rate per 1,000 receiving RX opioids at a high dosage for ≥15 days during the measurement year (average morphine equivalent dose [MED] >120 mg).
(A) A cluster of cognitive, behavioral, and physiological symptoms in which the individual continues use of opioids despite significant opioid-induced problems.
DSM-5: A problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least 2 out of 11 criteria within a 12-month period. Excludes those under Dr care for pain.
Citation source: CDER. (2018, August). Opioid Use Disorder: Endpoints for Demonstrating Effectiveness of Drugs for Medication-Assisted Treatment Guidance for Industry.
For members 18+ yrs, the rate/1,000 receiving Rx opioids for ≥15 days during the measurement year who receive opioids from multiple providers. Three rates are reported.
An at risk beneficiary at risk for abuse/diversion is a person who is enrolled in a plan, who receives a 2 or more prescriptions for controlled substances (any) in a period of 12 mos.
...adding these exemptions would align the drug mgmt programs with the CDC Guideline.