Medicare AdvantageAdministrativeLow impact
[New York] Statin Use in Persons with Diabetes: closing the statin gap for adults aged 40 to 75 with diabetes
Anthem BCBS·NY · Endocrinology, Cardiology, Internal Medicine +2 more·Provider Bulletin
Effective date
May 1, 2026
We identified it
May 3, 2026
Summary
This is an informational provider bulletin from Anthem Blue Cross Blue Shield regarding statin therapy for Medicare Advantage members aged 40-75 with diabetes. The policy emphasizes closing gaps in statin utilization through identification, initiation, intensification, and improved adherence to align with ADA/ACC/AHA guidelines and improve SUPD (Statin Use in Persons with Diabetes) Star measure performance. No billing code changes or prior authorization requirements are introduced.
Action Required
No immediate billing workflow changes required. Providers and clinical staff should: (1) Review the 'Four I's' framework (Identify, Initiate, Intensify, Improve adherence) for statin therapy in eligible diabetes patients; (2) Implement panel identification and care-gap outreach processes before patient visits; (3) Ensure prescription fills are tracked and follow up if claims do not appear in pharmacy system; (4) Maintain clear documentation of exclusions and true statin intolerance cases in patient records to support SUPD measure reporting. Billing team should monitor for any future Star measure reporting requirements related to SUPD performance.