| Appendix E: SCDTDP Measure Specifications |
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| Sickle Cell Treatment Demonstration Program |
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| Meaure Specifications and Codes |
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| Aim 1: Increase the number of providers treating persons with sickle cell disease |
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| Measure 1a: Number of providers in Plan who saw at least one patient younger than 18 years of age with SCD two or more times during the past 12 months |
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| Denominator Population: |
Providers who had at least one claim submitted to the plan during the 12 month period ending with the reference month. |
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| Numerator Population: |
Providers from the denominator population who saw at least one patient with SCD who was less than 18 years old at the time of the visit for at least two non-emergent outpatient visits (Table 2) during the 12 month period ending with the reference month. |
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| Exclusions: |
Patients who also have a diagnosis of sickle cell trait (Table 3) only should be excluded. |
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| Reporting Outputs: |
Denominator and numerator counts and percent. |
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| Reporting Interval: |
Monthly |
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| Comments: |
Claims include those paid, suspended, pending or denied. |
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| Measure 1b: Number of providers in Plan who saw at least one adult patient with SCD two or more times during the past 12 months |
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| Denominator Population: |
Providers who had at least one claim submitted to the plan during the 12 month period ending with the reference month. |
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| Numerator Population: |
Providers from the denominator population who saw at least one patient with SCD who was 18 years of age or older at the time of the visit for at least two non-emergent outpatient visits (Table 2) during the 12 month period ending with the reference month. |
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| Exclusions: |
Patients who also have a diagnosis of sickle cell trait (Table 3) only should be excluded. |
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| Reporting Outputs: |
Denominator and numerator counts and percent. |
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| Reporting Interval: |
Monthly |
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| Comments: |
Claims include those paid, suspended, pending or denied. |
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| Measure 1c: Number of providers in Plan who saw any patient with SCD two or more times during the past 12 months |
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| Denominator Population: |
Providers who had at least one claim submitted to the plan during the 12 month period ending with the reference month. |
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| Numerator Population: |
Providers from the denominator population who saw any patient with SCD for at least two non-emergent outpatient visits (Table 2) during the 12 month period ending with the reference month. |
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| Exclusions: |
Patients who also have a diagnosis of sickle cell trait (Table 3) only should be excluded. |
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| Reporting Outputs: |
Denominator and numerator counts and percent. |
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| Reporting Interval: |
Monthly |
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| Comments: |
Claims include those paid, suspended, pending or denied. |
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| Measure 1d: Number of children in Plan with SCD who had at least 2 outpatient visits in the past 12 months. |
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| Denominator Population: |
Patients less than 18 years old as of the end of the reference month who have ever had a diagnosis of sickle cell disease (Table 1) and who had at least one health care event (any claim) during the 12 month period ending with the reference month. |
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| Numerator Population: |
Patients from the denominator population who had at least two non-emergent outpatient visits (Table 2) during the 12 month period ending with the reference month. |
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| Exclusions: |
Patients who also have a diagnosis of sickle cell trait (Table 3) only should be excluded. |
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| Reporting Outputs: |
Denominator and numerator counts and percent. |
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| Reporting Interval: |
Monthly |
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| Comments: |
Claims include those paid, suspended, pending or denied. |
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| Measure 1e: Number of adults in Plan with SCD who had at least 2 outpatient visits in the past 12 months. |
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| Denominator Population: |
Patients who were 18 years old or older as of the end of the reference month who have ever had a diagnosis of sickle cell disease (Table 1) and who had at least one health care event (any claim) during the 12 month period ending with the reference month. |
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| Numerator Population: |
Patients from the denominator population who had at least two non-emergent outpatient visits (Table 2) during the 12 month period ending with the reference month. |
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| Exclusions: |
Patients who also have a diagnosis of sickle cell trait (Table 3) only should be excluded. |
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| Reporting Outputs: |
Denominator and numerator counts and percent. |
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| Reporting Interval: |
Monthly |
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| Comments: |
Claims include those paid, suspended, pending or denied. |
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| Aim 2: Increase the number of providers prescribing hydroxyurea |
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| Measure 2a: Number of providers in Plan who prescribed hydroxyurea to a child with SCD at least once during the past 12 months |
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| Denominator Population: |
Providers who submitted at least one claim to the plan during the 12 month period ending with the reference month. |
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| Numerator Population: |
Providers from the denominator population who had a patient under 18 years old and who have a diagnosis of sickle cell disease (Table 1) and who filled at least one hydroxyurea prescription during the 12 month period ending with the reference month. |
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| Exclusions: |
Providers whose patients also have a diagnosis of sickle cell trait (Table 3) only should be excluded. |
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| Reporting Outputs: |
Denominator and numerator counts and percent. |
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| Reporting Interval: |
Monthly |
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| Comments: |
Claims include those paid, suspended, pending or denied. |
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| Measure 2b: Number of providers in Plan who prescribed hydroxyurea to an adult with SCD at least once during the past 12 months |
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| Denominator Population: |
Providers who submitted at least one claim to the plan during the 12 month period ending with the reference month. |
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| Numerator Population: |
Providers from the denominator population who had a patient over 18 years old and who have a diagnosis of sickle cell disease (Table 1) and who filled at least one hydroxyurea prescription during the 12 month period ending with the reference month. |
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| Exclusions: |
Providers whose patients also have a diagnosis of sickle cell trait (Table 3) only should be excluded. |
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| Reporting Outputs: |
Denominator and numerator counts and percent. |
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| Reporting Interval: |
Monthly |
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| Comments: |
Claims include those paid, suspended, pending or denied. |
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| Measure 2c: Number of providers in Plan who prescribed hydroxyurea at least once during the past 12 months |
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| Denominator Population: |
Providers who submitted at least one claim to the plan during the 12 month period ending with the reference month. |
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| Numerator Population: |
Providers from the denominator population who had any patient with a diagnosis of sickle cell disease (Table 1) who filled at least one hydroxyurea prescription during the 12 month period ending with the reference month. |
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| Exclusions: |
Providers whose patients also have a diagnosis of sickle cell trait (Table 3) only should be excluded. |
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| Reporting Outputs: |
Denominator and numerator counts and percent. |
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| Reporting Interval: |
Monthly |
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| Comments: |
Claims include those paid, suspended, pending or denied. |
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| Measure 2d: Number of children with SCD who filled a prescription for hydroxyurea at least once during the past 12 months |
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| Denominator Population: |
Patients less than 18 years old as of the end of the reference month who have ever had a diagnosis of sickle cell disease (Table 1) and who had at least one health care event (any claim) during the 12 month period ending with the reference month. |
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| Numerator Population: |
Patients from the denominator population who filled at least one hydroxyurea prescription during the 12 month period ending with the reference month. |
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| Exclusions: |
Patients who also have a diagnosis of sickle cell trait (Table 3) only should be excluded. |
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| Reporting Outputs: |
Denominator and numerator counts and percent. |
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| Reporting Interval: |
Monthly |
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| Comments: |
Claims include those paid, suspended, pending or denied. |
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| Measure 2e: Number of adults with SCD who filled a prescription for hydroxyurea at least once during the past 12 months |
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| Denominator Population: |
Patients 18 years of age or older as of the end of the reference month who have ever had a diagnosis of sickle cell disease (Table 1) and who had at least one health care event (any claim) during the 12 month period ending with the reference month. |
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| Numerator Population: |
Patients from the denominator population who filled at least one hydroxyurea prescription during the 12 month period ending with the reference month. |
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| Exclusions: |
Patients who also have a diagnosis of sickle cell trait (Table 3) only should be excluded. |
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| Reporting Outputs: |
Denominator and numerator counts and percent. |
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| Reporting Interval: |
Monthly |
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| Comments: |
Claims include those paid, suspended, pending or denied. |
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| Table 1: Codes to Identify Sickle Cell Disease |
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| Condition Name |
ICD-9 |
ICD-10 |
| Hb S beta‐thalassemia |
282.41, 282.42 |
D57.40, D57.41 |
| Hb SS‐disease (sickle cell anemia) |
282.6, 282.61, 282.62 |
D57 Sickle cell disorders |
| D57.0 Sickle cell anemia with crisis |
| D57.1 Sickle cell anemia without crisis |
| Hb SC‐disease |
282.63, 282.64 |
D57.20, D57.21 |
| Hb SD‐disease |
282.68, 282.69 |
D57.80, D57.81 |
| Hb SE‐disease |
282.68, 282.69 |
D57.80, D57.81 |
| Condition Name Hemoglobin Screening Result ICD‐9 Code(s) |
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| Table 2: Codes to Identify Outpatient Care |
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| Description |
CPT |
ICD-9 |
| Office or other outpatient services |
99201‐99205, 99211‐99215, 99241‐ |
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| 99245 |
| Preventive medicine |
99381‐99385, 99391‐99395, 99401‐ |
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| 99404, 99411‐99412, 99420, 99429 |
| General medical examination |
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V20.2, V70.0, V70.3, |
| V70.5, V70.6, V70.8 |
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| Table 3: Excluded Sickle Cell Related Codes |
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| Condition Name |
ICD-9 |
ICD-10 |
| Hb S (sickle)‐carrier (sickle cell trait) |
282.5 |
D57.3 |
| Proprietary Name |
Dosage Form name |
Application Number |
Package Description |
Product NDC |
Strength |
Product Type Name |
Non-Proprietary Name |
Route Name |
Market Category Name |
Labeler Name |
Substance Name |
Pharm Class |
DEA |
Start date |
End date |
| HYDROXYUREA |
CAPSULE |
ANDA075143 |
30 CAPSULE in 1 BOTTLE, PLASTIC (54868-4773-0) |
54868-4773 |
500 mg/1 |
HUMAN PRESCRIPTION DRUG |
Hydroxyurea |
ORAL |
ANDA |
Physicians Total Care, Inc. |
HYDROXYUREA |
N/A |
N/A |
4/11/2003 |
N/A |
| HYDROXYUREA |
CAPSULE |
ANDA075143 |
100 CAPSULE in 1 BOTTLE, PLASTIC (54868-4773-1) |
54868-4773 |
500 mg/1 |
HUMAN PRESCRIPTION DRUG |
Hydroxyurea |
ORAL |
ANDA |
Physicians Total Care, Inc. |
HYDROXYUREA |
N/A |
N/A |
4/11/2003 |
N/A |
| HYDROXYUREA |
CAPSULE |
ANDA075143 |
50 CAPSULE in 1 BOTTLE, PLASTIC (54868-4773-2) |
54868-4773 |
500 mg/1 |
HUMAN PRESCRIPTION DRUG |
Hydroxyurea |
ORAL |
ANDA |
Physicians Total Care, Inc. |
HYDROXYUREA |
N/A |
N/A |
4/11/2003 |
N/A |
| HYDROXYUREA |
CAPSULE |
ANDA075143 |
60 CAPSULE in 1 BOTTLE, PLASTIC (54868-4773-3) |
54868-4773 |
500 mg/1 |
HUMAN PRESCRIPTION DRUG |
Hydroxyurea |
ORAL |
ANDA |
Physicians Total Care, Inc. |
HYDROXYUREA |
N/A |
N/A |
4/11/2003 |
N/A |
| HYDROXYUREA |
CAPSULE |
ANDA075143 |
40 CAPSULE in 1 BOTTLE, PLASTIC (54868-4773-4) |
54868-4773 |
500 mg/1 |
HUMAN PRESCRIPTION DRUG |
Hydroxyurea |
ORAL |
ANDA |
Physicians Total Care, Inc. |
HYDROXYUREA |
N/A |
N/A |
4/11/2003 |
N/A |
| Hydroxyurea |
CAPSULE |
ANDA075340 |
100 CAPSULE in 1 BOTTLE (60429-265-01) |
60429-265 |
500 mg/1 |
HUMAN PRESCRIPTION DRUG |
Hydroxyurea |
ORAL |
ANDA |
Golden State Medical Supply, Inc. |
HYDROXYUREA |
N/A |
N/A |
2/24/1999 |
N/A |
| Hydroxyurea |
CAPSULE |
ANDA075340 |
100 BLISTER PACK in 1 BOX, UNIT-DOSE (68084-284-01) > 1 CAPSULE in 1 BLISTER PACK (68084-284-11) |
68084-284 |
500 mg/1 |
HUMAN PRESCRIPTION DRUG |
Hydroxyurea |
ORAL |
ANDA |
American Health Packaging |
HYDROXYUREA |
N/A |
N/A |
8/12/2008 |
N/A |
| HYDREA |
CAPSULE |
NDA016295 |
100 CAPSULE in 1 BOTTLE (0003-0830-50) |
0003-0830 |
500 mg/1 |
HUMAN PRESCRIPTION DRUG |
HYDROXYUREA |
ORAL |
NDA |
E.R. Squibb & Sons, L.L.C. |
HYDROXYUREA |
N/A |
N/A |
6/1/2009 |
N/A |
| DROXIA |
CAPSULE |
NDA016295 |
60 CAPSULE in 1 BOTTLE (0003-6335-17) |
0003-6335 |
200 mg/1 |
HUMAN PRESCRIPTION DRUG |
HYDROXYUREA |
ORAL |
NDA |
E.R. Squibb & Sons, L.L.C. |
HYDROXYUREA |
N/A |
N/A |
6/1/2009 |
N/A |
| DROXIA |
CAPSULE |
NDA016295 |
60 CAPSULE in 1 BOTTLE (0003-6336-17) |
0003-6336 |
300 mg/1 |
HUMAN PRESCRIPTION DRUG |
HYDROXYUREA |
ORAL |
NDA |
E.R. Squibb & Sons, L.L.C. |
HYDROXYUREA |
N/A |
N/A |
6/1/2009 |
N/A |
| DROXIA |
CAPSULE |
NDA016295 |
60 CAPSULE in 1 BOTTLE (0003-6337-17) |
0003-6337 |
400 mg/1 |
HUMAN PRESCRIPTION DRUG |
HYDROXYUREA |
ORAL |
NDA |
E.R. Squibb & Sons, L.L.C. |
HYDROXYUREA |
N/A |
N/A |
6/1/2009 |
N/A |
| HYDROXYUREA |
CAPSULE |
ANDA075143 |
100 CAPSULE in 1 BOTTLE (0555-0882-02) |
0555-0882 |
500 mg/1 |
HUMAN PRESCRIPTION DRUG |
Hydroxyurea |
ORAL |
ANDA |
Barr Laboratories Inc. |
HYDROXYUREA |
N/A |
N/A |
10/19/1998 |
N/A |
| HYDROXYUREA |
CAPSULE |
ANDA075143 |
100 CAPSULE in 1 BOTTLE (42291-321-01) |
42291-321 |
500 mg/1 |
HUMAN PRESCRIPTION DRUG |
Hydroxyurea |
ORAL |
ANDA |
AvKARE, Inc. |
HYDROXYUREA |
N/A |
N/A |
7/19/2013 |
N/A |
| Hydroxyurea |
CAPSULE |
ANDA075340 |
100 CAPSULE in 1 BOTTLE (49884-724-01) |
49884-724 |
500 mg/1 |
HUMAN PRESCRIPTION DRUG |
Hydroxyurea |
ORAL |
ANDA |
Par Pharmaceutical, Inc. |
HYDROXYUREA |
N/A |
N/A |
2/24/1999 |
N/A |