PQA Measure Use in CMS’ Part D Quality Programs

Medicare Part D Star Ratings

The Centers for Medicare & Medicaid Services (CMS) creates plan ratings that indicate the quality of Medicare plans on a scale of 1 to 5 stars with 5 stars being the highest rating. The overall star rating is determined through numerous performance measures across several domains of performance. Each measure is awarded a star rating and the individual measure stars are then aggregated at the domain and summary level. Only a small number of plans receive a 5-star summary rating from CMS, with most plans receiving 3 to 4 stars.

CMS manages the star ratings system and uses its contractor, Acumen, LLC, for the analyses of Medicare data to generate the rates for the medication measures. PQA maintains the PQA-endorsed performance measures and updates the technical specifications for the measures routinely. PQA also shares new measures that are endorsed by PQA with CMS and provides technical guidance on the use of the measures within the plan ratings. CMS tests updates to PQA-endorsed measure specifications and drug-code lists and implements them as appropriate.

Five PQA measures will be included in the 2024 Medicare Part D Star Ratings:

• Medication Adherence for Diabetes Medications
• Medication Adherence for Hypertension (RAS antagonists)
• Medication Adherence for Cholesterol (Statins)
• MTM Program Completion Rate for CMR
• Statin Use in Persons with Diabetes

CMS recently finalized its plans to implement PQA’s risk adjustment model for the adherence measures, which will be phased in over three years. PQA has a frequently asked questions (FAQ) document that addresses background and basics of sociodemographic status (SDS) risk adjustment and PQA’s risk adjustment recommendations for the adherence measures in Medicare Part D.

Other Frequently Asked Questions