The Centers for Medicare & Medicaid Services strengthened its commitment to monitoring patient safety with the addition of several PQA safety measures to the 2027 Part D Star Ratings (Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults [POLY-ACH], and Concurrent Use of Opioids and Benzodiazepines [COB]) and Display Page (Polypharmacy: Use of Multiple CNS-Active Medications in Older Adults [POLY-CNS]). A new publication in the Journal of Managed Care and Specialty Pharmacy provides insights into the quality issues associated with CNS-active medication polypharmacy suggesting that the rate of CNS-active polypharmacy is higher among enrollees of the Medicare Part D Medication Therapy Management (MTM) program compared to the general Medicare Fee-For-Service population. This finding isn’t surprising given the eligibility and targeting criteria for the Part D MTM program.  

The MTM program aims to optimize therapeutic outcomes and reduce the risk of adverse events and associated costs by identifying and addressing medication therapy problems. Given the higher risk of adverse events among older adults taking multiple CNS-active medications and the higher rate of CNS-active medication polypharmacy in the MTM program, interventions should target this potentially vulnerable population. The study also suggests that MTM enrollees who are male, dually enrolled in Medicaid, and have a greater comorbidity burden, healthcare utilization, and medication use are prime for receiving targeted interventions to reduce CNS-active polypharmacy. 

This study leveraged the PQA POLY-CNS measure to analyze the percentage of Medicare Part D beneficiaries, 65 years or older, with concurrent use of three or more unique CNS-active medications during the measurement period. The measure is based on the American Geriatrics Society Beers Criteria and for the project’s study period defined CNS-active medications as antidepressants, antipsychotics, benzodiazepine and nonbenzodiazepine sedative hypnotics, opioids, and antiepileptics.  

This project was spearheaded by Dr. Anna Hung at Duke University and her research affiliates. PQA would like to thank Dr. Hung for including PQA in the study to ensure accurate use and interpretation of PQA’s quality measures. If you would like to discuss using PQA measures in your research, please contact [email protected].