Description: The percentage of members who were diagnosed with rheumatoid arthritis and who were dispensed at least one ambulatory prescription for a disease-modifying anti-rheumatic drug (DMARD).
||Commercial, Medicaid, Medicare (report each product line separately).
||18 years and older as of December 31 of the measurement year.
||The measurement year.
||No more than one gap in enrollment of up to 45 days. To determine continuous enrollment for a Medicaid beneficiary for whom enrollment is verified monthly, the member may not have more than a 1-month gap in coverage (i.e., a member whose coverage lapses for 2 months [60 days] is not considered continuously enrolled).
||December 31 of the measurement year.
||Medical and pharmacy.
||Two of the following with different dates of service on or between January 1 and November 30 of the measurement year. Visit type need not be the same for the two visits.
Denominator Exclusions (when applicable)
- A diagnosis of HIV (HIV Value Set; HIV Type 2 Value Set) any time during the member’s history through December 31 of the measurement year.
- A diagnosis of pregnancy (Pregnancy Value Set) any time during the measurement year.
||Members who had at least one ambulatory prescription dispensed for a DMARD during the measurement year. There are two ways to identify members who received a DMARD: by claim/encounter data and by pharmacy data. The organization may use both methods to identify the numerator, but a member need only be identified by one method to be included in the numerator.
Claim/encounter data. A DMARD prescription (DMARD Value Set) during the measurement year.
Pharmacy data. Members who were dispensed a DMARD during the measurement year on an ambulatory basis (Table ART-C).