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 twice annually. PQA also shares new measures that are endorsed by PQA with CMS and provides some 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 they deem appropriate.

Five PQA measures will be included in the 2019 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

Frequently Asked Questions

What's new for the 2019 Medicare Part D Star Ratings?

CMS added the PQA Statin Use in Persons with Diabetes measure for the 2019 Medicare Part D Star Ratings. With the addition of this measure, the plan ratings will be comprised of 14 measures including the five PQA measures that are positioned within the domain of Drug Safety and Accuracy of Drug Pricing.

The measures included in the Part D Star Ratings and their respective weightings are listed below. The PQA measures are highlighted in green.

Measure Name20182019
Call Center - Foreign Language Interpreter and TTY Availability 1.5 1.5
Appeals Auto-Forward 1.5 1.5
Appeals Upheld 1.5 1.5
Complaints about the Drug Plan 1.5 1.5
Members Choosing to Leave the Plan 1.5 1.5
Drug Plan Quality Improvement 5 5
Rating of Drug Plan 1.5 1.5
Getting Needed Prescription Drugs 1.5 1.5
MFP Price Accuracy 1 1.5
Medication Adherence for Diabetes Medications* 3 3
Medication Adherence for Hypertension (RAS antagonists)* 3 3
Medication Adherence for Cholesterol (Statins)* 3 3
MTM Program Completion Rate for CMR 1 1
Statin Use in Persons with Diabetes N/A 1

*For contracts that solely serve the population of beneficiaries in Puerto Rico, CMS will continue to reduce the weights for the adherence measures to zero for the summary and overall rating calculations and maintain the weight of three for the improvement measure calculations.

Which PQA measures are included on the Medicare Part D Display Page?

Beyond the Star Ratings, CMS uses the Display Page to provide further evaluation of Part D plans. The Display Page measures are not included in the plan ratings but are used to facilitate quality improvement by the plans.

For the 2019 Star Ratings, the Statin Use in Persons with Diabetes measure moved from the Display Page to the plan ratings. Additionally, the Use of Opioids at High Dosage and from Multiple Providers measure was added to 2019 Display Page.

The PQA-endorsed measures on the Display Page include:

Measure Name20182019
Drug-Drug Interactions
Diabetes Medication Dosing
Statin Use in Persons with Diabetes
High Risk Medications in the Elderly
Antipsychotic Use in Persons with Dementia
Use of Opioids at High Dosage and from Multiple Providers

How does CMS use other PQA measures?

Several PQA measures are reported to plans in their Patient Safety Reports including:

  • HIV Antiretroviral Medication Adherence
  • Use of Opioids at High Dosage in Persons without Cancer
  • Use of Opioids from Multiple Providers in Persons without Cancer
  • Use of Opioids at High Dosage and from Multiple Providers in Persons without Cancer