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 2026 Medicare Part D Star Ratings:
In recent years, CMS finalized its plans to implement PQA’s risk adjustment model for the adherence measures, which will be phased in over three years, becoming effective as of the 2026 Measurement Year (2028 Star Ratings). 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. CMS finalized its plans to include the Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (POLY-ACH) and Concurrent Use of Opioids and Benzodiazepines (COB) measures in the 2025 Measurement Year (2027 Part D Star Ratings). CMS also finalized its plans to move the MTM Program Completion Rate for CMR measure from the Star Ratings to the Display Page for the 2025 Measurement Year (2027 Part D Display Page). For additional detail, we recommend reviewing the PQA summary of the 2025 Final Rule (CMS-4205-F). Other Frequently Asked Questions What's new for the 2026 Medicare Part D Star Ratings?For the 2026 Medicare Part D Star Ratings, the plan ratings will be composed 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. 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 measures do not contribute to the plan ratings but are publicly reported and can be used to facilitate quality improvement by the plans. The PQA-endorsed measures on the Display Page include:
How does CMS use other PQA measures?Several PQA measures are reported to plans in their 2025 Patient Safety Reports including:
Last Update: May 2025 |