Medicare AdvantageDocumentationMedium impact
[Ohio] Statin Use in Persons with Diabetes: closing the statin gap for adults aged 40 to 75 with diabetes
Anthem BCBS·OH · Endocrinology, Cardiology, Internal Medicine +2 more·Provider Bulletin
Effective date
May 1, 2026
We identified it
May 3, 2026
Summary
This is an informational bulletin from Anthem Blue Cross emphasizing statin therapy for Medicare Advantage members aged 40-75 with diabetes to improve the SUPD (Statin Use in Persons with Diabetes) Star measure. The policy recommends a four-step approach: Identify eligible patients, Initiate statin therapy, Intensify as needed, and Improve adherence. No billing code changes or new coverage restrictions are introduced—this is guidance to close treatment gaps and improve performance metrics.
Action Required
By May 1, 2026: Clinical and care management teams should implement statin therapy gap-closure initiatives for Medicare Advantage members aged 40-75 with diabetes. Specifically: (1) Identify eligible patients with diabetes who are not on statin therapy through panel reports; (2) Conduct outreach and gap-closure visits before annual appointments; (3) Ensure same-day prescribing protocols are in place when appropriate; (4) Coordinate with pharmacy to confirm first fill and track claim submission; (5) Document any statin intolerance or exclusions clearly in the medical record to maintain clean SUPD reporting. Billing teams should ensure no barriers exist in the system that would prevent claim processing for statin prescriptions. Failure to address statin therapy gaps will negatively impact SUPD Star measure performance, which affects plan quality ratings and member satisfaction scores.