Potentially Harmful Drug-Disease Interactions in Older Adults (DDE)

Date: 04/07/23

The National Committee for Quality Assurance (NCQA) accredits health plans based on the structure and processes they have in place to maintain the highest level of clinical quality and patient satisfaction. NCQA utilizes the Healthcare Effectiveness Data and Information Set (HEDIS®) to track and analyze how health plans are performing.¹

One of the HEDIS® measures includes the evaluation of Wellcare By Allwell (Medicare Advantage) and STAR+PLUS Medicare-Medicaid Plan (MMP) populations for “Medication Management in the Elderly.” This measure includes a category for “Potentially Harmful Drug-Disease Interactions in Older Adults (DDE)” that assesses the utilization of certain ambulatory prescription drugs in adults who are 65 and older that have a specific disease where the use of the medication could worsen or complicate the underlying condition.

The use of these harmful medications concurrently with the diagnosis, or after, could cause avoidable adverse drug events contributing to additional hospitalizations, exacerbated illness, nursing home placement and falls/fractures.¹ The goal of monitoring this measure is to reduce medication-related problems and adverse drug events in the Medicare population.

The DDE measure tracks 3 disease states and specific classes of medications that are being used concurrently. The performance of this measure is based on the rate of prescriptions for each of the specified disease states where a lower rate represents a better overall performance.

The following diseases and associated drug classes are tracked for performance. Please evaluate your patients who have had the following conditions prior to prescribing the specified drug classes listed below:

• Chronic Kidney Disease (CKD): COX-2 selective non-steroidal anti-inflammatory drugs (NSAIDs) or all non-aspirin NSAIDs.
  • Excludes hospice patients or those using hospice services and palliative care.
• Dementia: Antipsychotics, Benzodiazepines, Non-benzodiazepine Hypnotics, Tricyclic Antidepressants or Anticholinergic Agents.
  • Excludes patients who have a diagnosis of psychosis, schizophrenia, schizoaffective disorder or bipolar disorder up to 2 years prior to the prescription.
  • Excludes hospice patients or those using hospice services and palliative care.
• History of Falls or Hip Fracture: Antiepileptics, Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), Antipsychotics, Benzodiazepines, Non-benzodiazepine Hypnotics or Tricyclic Antidepressants.
  • Excludes patients who have a diagnosis of psychosis, schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder or seizure disorder up to 2 years prior to the prescription.
  • Excludes hospice patients or those using hospice services and palliative care.

To review a summary for this measure and specific drug classes, please review the tables below:

MEASURE	DISEASE	PERFORMANCE
Potentially Harmful Drug-Disease Interactions in Older Adults (DDE): The rate of Medicare members who are 65 and older that are dispensed a harmful medication concurrently or after a diagnosis is on the member’s health record.	Chronic Kidney Disease (CKD)	A lower rate is indicative of a better performance for the health plan.   Please evaluate the member for any of the conditions listed prior to prescribing the medications listed below.
	Dementia
	History of Falls or Hip Fracture

POTENTIALLY HARMFUL DRUGS FOR PATIENTS WITH CKD
DESCRIPTION	PRESCRIPTION
COX-2 Selective NSAID	Celecoxib
Non-aspirin NSAIDs	Diclofenac potassium, Diclofenac sodium, Etodolac, Fenoprofen, Flurbiprofen, Ibuprofen, Indomethacin, Ketoprofen, Ketorolac, Meclofenamate, Mefenamic acid, Meloxicam, Nabumetone, Naproxen, Naproxen sodium, Oxaprozin, Piroxicam, Sulindac and Tolmetin

POTENTIALLY HARMFUL DRUGS FOR PATIENTS WITH DEMENTIA
DESCRIPTION	PRESCRIPTION
Anticholinergic Agents, Antiemetics	Prochlorperazine and Promethazine
Anticholinergic Agents, Antihistamines	Brompheniramine, Carbinoxamine, Chlorpheniramine, Clemastine, Cyproheptadine, Dexbrompheniramine, Dexchlorpheniramine, Dimenhydrinate, Diphenhydramine, Doxylamine, Hydroxyzine, Meclizine, Pyrilamine and Triprolidine
Anticholinergic Agents, Antispasmodics	Atropine, Belladonna alkaloids, Clidinium-Chlordiazepoxide, Dicyclomine, Homatropine, Hyoscyamine, Methscopolamine, Propantheline and Scopolamine
Anticholinergic Agents, Antimuscarinics	Darifenacin, Fesoterodine, Flavoxate, Oxybutynin, Solifenacin, Tolterodine, and Trospium
Anticholinergic Agents, Anti-Parkinson Agents	Benztropine and Trihexyphenidyl
Anticholinergic Agents, Skeletal Muscle Relaxants	Cyclobenzaprine and Orphenadrine
Anticholinergic, SSRIs	Paroxetine (has anticholinergic properties)
Anticholinergic Agents, Antiarrhythmic	Disopyramide

POTENTIALLY HARMFUL DRUGS FOR PATIENTS WITH HISTORY OF FALLS
DESCRIPTION	PRESCRIPTION
Antiepileptics	Carbamazepine, Clobazam, Divalproex sodium, Ethosuximide, Ethotoin, Ezogabine, Felbamate, Fosphenytoin, Gabapentin, Lacosamide, Lamotrigine, Levetiracetam, Methsuximide, Oxcarbazepine, Phenobarbital, Phenytoin, Pregablin, Primidone, Rufinamide, Tiagabine HCL, Topiramate, Valproic acid, Vigabatrin and Zonisamide
SNRIs	Desvenlafaxine, Duloxetine, Levomilnacipran and Venlafaxine
SSRIs	Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine and Sertraline

POTENTIALLY HARMFUL DRUGS FOR PATIENTS WITH HISTORY OF FALLS OR DEMENTIA
DESCRIPTION	PRESCRIPTION
Antipsychotics	Aripiprazole, Aripiprazole lauroxil, Asenapine, Brexpiprazole, Cariprazine, Chlorpromazine, Clozapine, Fluphenazine, Haloperidol, Iloperidone, Loxapine, Lurasidone, Molindone, Olanzapine, Paliperidone, Perphenazine, Pimozide, Quetiapine, Risperidone, Thioridazine, Thiothixene, Trifluoperazine and Ziprasidone
Benzodiazepines	Alprazolam, Chlordiazepoxide, Clonazepam, Clorazepate, Diazepam, Estazolam, Flurazepam, Lorazepam, Midazolam, Oxazepam, Quazepam, Temazepam and Triazolam
Non-Benzodiazepine Hypnotics	Eszopiclone, Zaleplon and Zolpidem
Tricyclic Antidepressants	Amitriptyline, Amoxapine, Clomipramine, Desipramine, Doxepin (> 6 mg), Imipramine, Nortriptyline, Protriptyline and Trimipramine

^{1. Medication Management in Older Adults (DDE/DAE). NCQA. Accessed August 3, 2022}