ART: Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis
Percentage of RA members who received at least one ambulatory dispensing of DMARD during measurement year.
Measure description
Percentage of RA members who received at least one ambulatory dispensing of DMARD during measurement year.
Eligible population
Members with RA diagnosis
Performance drivers
Under-treatment of RA with DMARDs (MTX preferred first-line).
Documentation & PA strategy
Document RA diagnosis (M05/M06), DMARD prescription. PA for biologic DMARDs often streamlined when MTX step documented.
Why HEDIS matters for prior authorization
Health plans align prior authorization criteria with HEDIS measures: documenting your patient meets the HEDIS definition often streamlines or eliminates PA hurdles. For Medicare Advantage in particular, plans are heavily incentivized via Star Ratings to push members and providers toward measure compliance, which translates into faster approvals for measure-aligned services.
Frequently asked questions
What does HEDIS measure ART measure?
Percentage of RA members who received at least one ambulatory dispensing of DMARD during measurement year.
What drives performance on this measure?
Under-treatment of RA with DMARDs (MTX preferred first-line).
How should clinicians document for this measure?
Document RA diagnosis (M05/M06), DMARD prescription. PA for biologic DMARDs often streamlined when MTX step documented.
What is the eligible population?
Members with RA diagnosis
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