Aligning With the Right PBM: Why Medicare Star Ratings Matter

As member ratings, complaints and other experience measures play a greater role in the Medicare Star Rating program, having the right pharmacy benefit management team has become increasingly critical to health plan success.

BACKGROUND

In 2008, the Centers for Medicare and Medicaid Services (CMS) launched the Star Rating program to measure the quality of Medicare Part D Plans (PDP) and Medicare Advantage Plans (MAPD) and help Medicare beneficiaries make more informed decisions about the coverage they purchase.

PHARMACY QUALITY ALLIANCE AWARD: HIGH ACHIEVEMENT IN MEDICATION QUALITY MEASURES

On May 13, 2021, Navitus received the 2021 Pharmacy Quality Alliance (PQA) Laura Cranston Excellence in Quality Award for our prescription drug plan, Navitus MedicareRx. According to PQA, this award demonstrates Navitus’ exemplary management of medications for Medicare members and our commitment to high-quality medication use strategies to care for plan sponsors and their members.

This award goes to PDPs with at least a 4.5 Medicare Part D summary rating and a 4-star rating on all five PQA medication measures used within the 2021 CMS Star Ratings Program. In 2021, Navitus MedicareRx received a 4.5 out of 5 summary rating, making it Navitus’ third year to receive a Star Rating of 4.5 and our fifth year to rank higher than any other PBM-sponsored Medicare PDP Employer Group Waiver Plan. Navitus is one of nine health care organizations to receive PQA’s Excellence in Quality Award for PDPs this year, highlighting our industry-leading clinical programs that work together to address medication adherence.

UNDERSTANDING MEASUREMENT AND MANAGEMENT TOOLS TO CONTROL COSTS

Taking medications as prescribed is critical for improving member health outcomes and preventing unnecessary costs. However, medication non-adherence is a longstanding issue in the United States. In fact, according to the U.S. Food & Drug Administration, medications are not taken as prescribed 50% of the time.¹ To help members navigate the complex medication journey, Navitus offers solutions designed to improve clinical outcomes, maximize interventions, reduce costs and provide the personalized support they need to stay adherent.

In this new era of performance, understanding how your PBM measures up in terms of quality is an essential starting point.

“The effective use of medications is a top issue for all care providers, and it is extremely important in the Medicare Part D program,” Micah Cost, PharmD, MS, chief executive officer at PQA said. “This year, PQA recognizes 16 plans for their exemplary management of medications for their Medicare members. The excellence and improvement recognized by these awards reflect the organizations’ commitment to high quality medication use strategies by the plans and their partners to care for patients.”

At Navitus, plan sponsors and their members are at the center of everything we do, and this dedication is reflected in our consistently exemplary Medicare quality measures.

LOOKING DEEPER: THE IMPORTANCE OF SUBCATEGORY RATINGS

Health plans and members should not only evaluate the overall Star Rating of their prescription drug plan, but they should also consider performance in the individual subcategories. In 2021, Navitus earned a rating of 4 Stars or higher in five categories:

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

WHAT THIS MEANS FOR PLAN SPONSORS

Medicare quality measures highlight a PBM’s commitment to helping members achieve the best health by managing their chronic conditions through effective, individualized services.

Best-in-class clinical care and superior customer service are foundational to our MedicareRx program. There are many factors that influence a member’s ability to adhere to their medications. As the pandemic continues to exacerbate these barriers to adherence, especially among the senior population, our consistently strong Star Ratings are just one of many indicators that demonstrate our ability to deliver high-touch services that lower costs and improve health outcomes.

Why You Need to Take Your Medications as Prescribed or Instructed. U.S. Food & Drug Administration. https://www.fda.gov/drugs/special-features/why-you-need-take-your-medications-prescribed-or-instructed. Updated February 16, 2016. Accessed May 20, 2021.