In today’s Medicare Advantage (MA) landscape, drug measures have become both more complex and more consequential. With CMS placing greater weight on Part D performance—and health plans across the country struggling to maintain their Star Ratings—success increasingly depends on how well plans can manage medication adherence, safety, and appropriateness.
This article outlines the essential knowledge and strategies every plan needs to navigate the changing drug measure landscape effectively.
Overview of Drug Measures
Drug measures make up approximately one-third of the total weight in Medicare Advantage Star Ratings. With the industry-wide decline in performance—average Star Ratings dropping below 4.0 for the first time in a decade—many plans now find themselves in a steep climb just to maintain eligibility for bonuses and high-performance branding.
Part D scores have seen particularly steep declines, and plans that fail to improve them will struggle to achieve a 4-Star rating or better. Yet these measures also present one of the most addressable areas for improvement—if plans are willing to invest early and strategically in interventions, data infrastructure, and member and provider engagement.
The Three Types of Drug Measures
Drug-related Star measures fall into three major categories, each with its own challenges, intervention tactics, and implications for performance.
- Core Medication Adherence Measures
These include adherence for diabetes medications, statins, and hypertension drugs (RAS antagonists). To be counted as adherent, members must maintain at least 80% days covered over the calendar year. These are high-impact, 3x-weighted measures, which means even small declines can have outsized effects on overall scores. Plans must monitor adherence continuously throughout the year and intervene quickly to prevent lapses. - Statin Measures
This includes statin use in people with diabetes (SUPD) and those with cardiovascular disease (SPC). In the case of SPC, compliance requires not just any statin use, but specifically moderate-to-high intensity therapy. Lack of provider awareness or variation in prescribing habits can severely impact scores - Polypharmacy Measures
These newer measures include concurrent use of opioids and benzodiazepines, and duplicate therapy for anticholinergic agents. These are technically complex and require tight coordination across prescribers to avoid inappropriate combinations or excessive durations. While currently lower weighted, their complexity and potential risk to patients make them a high-priority focus for many plans.
Drug Measures vs Clinical Measures
Compared to traditional HEDIS clinical measures, drug measures are a different beast—and they demand a different operational playbook.
Timing and Data Lag
HEDIS data is largely under a plan’s control and can be managed in near-real time. In contrast, drug measure performance is heavily dependent on lagging CMS reports and data passed through intermediaries like PBMs and Acumen. Plans often receive insights too late to intervene effectively unless they develop their own real-time analytics.
Nature of Care/Adherence Gaps
Clinical gaps (like a missed A1C test) are binary and predictable. Drug adherence, by contrast, is cumulative and degrades over time—a few missed days here and there can snowball into non-compliance. Similarly, inappropriate polypharmacy can happen instantly with a single overlapping fill from a different provider.
Intervention Complexity
Closing gaps in clinical care often involves straightforward services like labs or screenings. With drug measures, plans must navigate a more personal and behavioral set of challenges: member forgetfulness, affordability, side effects, or confusion due to multiple prescribers. And since many drug-related interventions require provider involvement, plans must be proactive about educating and partnering with clinicians to adjust regimens safely and compliantly.
Data Challenges of Drug Measures
Data fragmentation and lag are among the most significant obstacles to improving drug measure performance.
The performance of drug measures depends on an intricate web of data flows between plans, PBMs, CMS, and third-party vendors like Acumen. Eligibility data, pharmacy claims, PDE submissions, and medical encounters all play a role—and any breakdown in these processes can lead to members being inaccurately scored or inappropriately included in denominators.
Plans often lack visibility into whether PDEs are submitted correctly, whether Acumen is applying exclusions accurately, or whether the right data is making it to CMS. And with Acumen reports typically lagging by two months or more, plans that rely solely on them are operating in the past—making timely interventions nearly impossible.
The solution lies in running internal versions of the drug measures on current, cleaned data. This allows plans to intervene in real time and spot discrepancies in CMS or Acumen reports early enough to appeal or correct them.
Drug Measure Best Practices
Improving drug measure performance requires more than surface-level interventions. Plans that succeed treat this as a multi-layered operational challenge—one that cuts across data infrastructure, member and provider engagement, and enterprise coordination. Below are five key pillars of high-impact strategies, with practical tactics under each.
1) Real-Time Data
To move the needle on adherence and safety measures, plans must abandon reliance on outdated or lagging reports. The best performers use near real-time data to guide decision-making.
Best Practices:
- Use RxClaims data instead of PDEs for more current and comprehensive views of prescription activity.
- Incorporate medical claims for exclusions and adjustments—key to accurate measure calculations and appeals.
- Run your own internal versions of the drug measures rather than waiting for Acumen reports to identify gaps.
- Reduce or eliminate claims lag through tighter PBM integration and frequent data updates.
- Do not rely solely on Acumen Patient Safety Reports, which are retrospective and can mask urgent trends.
2) Member Strategies
Adherence is behavioral—and deeply personal. Plans must anticipate drop-offs before they happen, and tailor interventions to members’ real-world barriers.
Best Practices:
- Use risk identification tools to proactively reach out via text, IVR, or live calls—especially to members approaching non-adherence thresholds.
- Enroll members in auto-refill and 90-day supply programs, which significantly reduce refill gaps.
- Engage members clinically, not just administratively, with pharmacists or case managers addressing side effects and medication understanding.
- Address social risk factors like transportation, food insecurity, or financial barriers that impact adherence.
- Route cognitively impaired members to case management for extra support.
- Incorporate medication access and adherence barriers into HRAs, giving care teams visibility into issues affecting Stars performance.
3) Provider Strategies
Providers play a crucial role in drug adherence and safety—especially when multiple prescribers are involved. Outreach must be clinically actionable and aligned with workflows.
Best Practices:
- Distribute weekly provider panel lists that are focused, timely, and highlight patients at highest risk.
- Send targeted alerts to prescribers for cases of risky medication combinations or duplicate therapies.
- Provide drug measure report cards and link them to value-based care incentives when possible.
- Educate providers on drug measure specifications, including intensity requirements and safety thresholds.
- Deploy pharmacist-led outreach to engage clinical teams and close gaps more effectively.
4) Leverage the Enterprise
Plans that silo Stars performance into a single team or department often miss critical opportunities. High-performing organizations activate all corners of the business.
Best Practices:
- Coordinate with MTM programs or dedicated adherence units to unify outreach efforts.
- Empower case managers and pharmacy staff to provide targeted medication education (e.g., explaining statin recommendations).
- Work closely with care transitions teams to prevent “long gaps” after hospitalizations or procedures.
- Incorporate drug measure performance into HRAs and care plans, embedding Stars improvement into routine member touchpoints.
5) Ongoing Data Reconciliation
The work doesn’t end with data collection—it’s just the beginning. Plans must actively verify, reconcile, and correct the information that determines CMS-calculated scores.
Best Practices:
- Validate PDEs for completeness, accuracy, and timeliness to ensure all eligible fills are counted.
- Reconcile internal data (eligibility, PDEs, medical encounters) against CMS and Acumen reports to spot discrepancies early.
- Report any mismatches during the Plan Preview period, and submit appeals when necessary—CMS allows for corrections, but only within strict timelines.
Conclusion
Improving drug measure performance isn’t just a data challenge—it’s a strategic opportunity. Plans that approach it with rigor, cross-functional coordination, and modern data tools can not only raise their Star Ratings but also improve member outcomes and operational efficiency. As CMS continues to emphasize medication safety, appropriateness, and adherence, investing in smarter drug measure management will be a defining factor for plan success.
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About Lilac
Are you one of the many plans struggling with drug measure achievement? Lilac Software has created a state-of-the-art technology platform aimed at high drug measure achievement. Our PQA-licensed engine has been specifically designed to help you implement the best practices above, including:
- Closing the time gap by using pharmacy claims
- Running measures as often as daily
- Publishing daily and weekly gap lists for research, plan departments, and providers.
- Validating PDEs
- Reconciling CMS Acumen and Plan drug data for each measure
Learn more by visiting our MA Drug Measure Solution page or start a conversation by filling out the form in this link.
