Star data shows that one of the most difficult performance categories in Star are drug measures. With Measure Year 2024 needing completion for Star Year 2026 and Measure Year 2025 ready to begin for Star Year 2027, here are some key things Medicare Advantage (MA) and Part D plans need to know about the drug measures.
What makes ongoing drug measure performance a struggle?
Unlike the clinical measures, plans do not calculate most drug measures – CMS does. While CMS makes available patient safety and adherence reports, CMS alone calculates the measures, the data and calculations lag due to that process, and there is less understanding of the measures themselves (e.g., eligibility, exclusions, adjustments, included and excluded drugs, compliance, and adherence.) Both medical and pharmacy claims are needed. As well, unlike most clinical measures which are “one-and-done” (you become compliant with one hit), medication adherence and drug safety measures need year-round tracking and remediation. Further, it is not enough to get to an adherence rate like 80% to get a high score on a medication adherence measure. Finally, I think of drug measures as having three different types, which complicates remediation activities as each type must be approached somewhat differently.
What are the average ratings for drug measures for Star Year 2025?
The SY 2025 data tells us drug measures remain very challenging. Scores are low and dropping on a majority of the five measures. The three medication adherence measures are each 3x weighted. As you can see below, these measures weigh down on overall rating achievement. They are in the low 3s and high 2s.
- Statin Therapy for Cardiovascular Disease (HEDIS Part C) – 3.3 in SY 2024 to 3.0 in SY 2025
- Medication Adherence Diabetes (PQA Part D) – 3.3 in SY 2024 to 3.2 in SY 2025
- Medication Adherence RAS Antagonists (PQA Part D) – 3.4 in SY 2024 to 3.3 in SY 2025
- Medication Adherence for Cholesterol (Statins) (PQA Part D) – 3.2 in SY 2024 to 3.3 in SY 2025
- Statin Use in Persons with Diabetes (PQA Part D) – 2.7 in SY 2024 to 2.8 in SY 2025
New measures for MY 2025/SY 2027
Complicating things further is the fact that there are two new measures coming in for MY 2025/SY 2027 and these are different types of measures than in Star now.
- Concurrent Use of Opioids and Benzodiazepines (1x for SY 2027) – This measure determines the percentage of individuals ≥18 years with concurrent use of prescription opioids and benzodiazepines for ≥30 cumulative days.
- Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) – this measure determines the percentage of individuals ≥65 years of age older adults with concurrent use of ≥2 unique anticholinergic medications.
Deep dive on the three different types of measures
In essence we have three different types of drug measures, which complicates activities to drive remediation and improvement.
1) Strict Compliance:
The two Statin measures are what I would call compliance measures. One or two script fills during the year is all you need. While MA plans have found these challenging, these are the easiest to achieve on. The challenge here is to drive fills for populations with the covered disease states.
2) Medication Adherence:
In the three Medication Adherence measures you need to drive the proportion of days covered (PDC) for the entire year to reach optimal fill rates for the drug. While many see a good adherence rate as 70% to 80% throughout the year, the latest cut points mean you have to achieve PDC rates overall in the high 80s and low 90s to receive 4 or 5 Star ratings on each of the three measures. That is a tough task as that means more than one missed monthly fill overall per eligible member makes it impossible to hit 4 or 5 Star on the measures. The challenge here is staying on top of fills daily or weekly to identify gaps so as to achieve the highest PDC possible.
3) Drug Safety:
In some ways, the two new measures on drug safety may be the hardest to succeed on. You are looking for duplicative or concurrent use of unsafe drugs in vulnerable or elderly populations. And more than 30 days on the concurrent or unsafe drug combinations means the enrollee is non-compliant for the entire year. MA plans must evaluate the use of multiple medications that interact and could cause major safety impacts to enrollees. The challenge here is finding patients on the duplicative and unsafe therapies and working with perhaps multiple providers to reverse the problem very quickly.
Important note on the two new drug safety measures: start working those measures in December (if you haven’t already)! You might have members fall out of compliance in January. You should analyze potential non-compliant members and outreach to their providers to adjust therapies. This is key as unsafe, duplicative therapy for the month of January will mean losing the chance to make them compliant for all of MY 2025.
Conclusion
Drug measures remain a huge problem for MA and Part D plans. The drug measure category has a diversity of measures that span simple compliance to medication adherence to drug safety. Some measures are 3x weighted and poor performance on these hit overall ratings hard. Great performance on these measures requires a keen focus daily and weekly with both members and providers.
In the next edition, we will tell you about some best practices for high drug measure achievement and what we have built into our platform to help you excel.
Are you looking to improve your plan’s Star ratings, especially your drug measures? Learn more about Lilac’s Stars analytics platform or reach out to start a conversation here.
