Medication Adherence Star Measures Trip Up Part D Plans

By Jane Anderson

Both stand-alone Medicare Prescription Drug Plans and Medicare Advantage prescription drug (MA-PD) plans struggled this year with star rating measures for medication adherence and comprehensive medication review. But while MA-PD plans continued to make some progress on those measures, PDP plans fell shorter, in part because they don’t have the same financial incentives to improve, analysts say.

PDPs struggled with all three medication adherence measures: Medication Adherence for Diabetes Medications, Medication Adherence for Hypertension (RAS antagonists) and Medication Adherence for Cholesterol (Statins).

Meanwhile, MA-PDs had trouble on the new Statin Use in Persons with Diabetes, MTM Completion Rate, and two of the medication adherence measures (for hypertension and cholesterol).

Still, MA-PDs eked out some improvement, says Melissa Smith, senior vice president of sales, marketing, strategy and stars for Gorman Health Group. "In MA-PD, the national average for these four measures continued rising in the 2019 ratings. The continuously rising performance impacts cutpoints — which are determined after the performance period ends. That always presents challenges to plans."

MA-PDs have a powerful financial incentive to improve their performance on star measures, says Cary Badger, principal at HealthScape Advisors, LLC, in Chicago. "Plans on the PDP side don't have that" since they don't earn star-related bonuses, he says.

Integrated health plans such as Kaiser Permanente's MA-PD plans tend to do well on Part D measures, Badger says, because their integrated nature allows them to closely track prescription habits and use peer review to influence those habits. "They're just better at it because they are doing it in one constant workflow," he adds.

But stand-alone Part D plans don't have that type of influence over prescribers, Badger notes. Therefore, they wind up trying to influence patient behavior at the pharmacy window, he says. "Some of the work we're doing is to provide real-time feedback to the doctors as to what patients are filling — what kind of adherence they're getting," he says.

Meanwhile, PDPs can incorporate that information into an augmented peer review process to try to influence prescriber behavior, imitating the systems set up for fully integrated health plans, Badger says. 

From RADAR on Drug Benefits