PQA Measure Use in CMS’ Part D Quality ProgramsMedicare Part D Star RatingsThe 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 2023 Medicare Part D Star Ratings:
Frequently Asked Questions What's new for the 2023 Medicare Part D Star Ratings?For the 2023 Medicare Part D Star Ratings, the plan ratings will be comprised of 12 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. For 2023, the Statin Use in Persons with Diabetes measure will be re-classified as a process measure with a weight of 1. The PQA measures are highlighted in green.
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. The Drug-Drug Interactions and Use of Opioids at High Dosage and from Multiple Providers measures were retired from the 2022 Display Page. The Initial Opioid Prescribing for Long-Duration measure will be added to the 2023 Display Page. The PQA-endorsed measures currently on the Display Page include:
How does CMS use other PQA measures?Several PQA measures are reported to plans in their Patient Safety Reports including:
The Persistence to Basal Insulin measure was added to the Patient Safety Reports for 2022.
Last Update: April 2022 |