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When it comes to Star Ratings
for Medicare plans, 2023 represented a return to the
status quo after CMS stopped making
adjustments related to the COVID-19 public health emergency that had largely
inflated plans’ performance. Stand-alone Prescription Drug Plans (PDPs) were
no exception to that trend, but they also continued a phenomenon seen in
prior years where their overall scores trailed that of the more comprehensive
Medicare Advantage-Prescription Drug (MA-PD) plans.
Star Ratings matter more
for Medicare Advantage
- “I think PDPs
likely have some of the same challenges that MA plans have, in terms of
the regulatory adjustments [for the pandemic] going away,” observes Tom
Kornfield, a senior consultant at Avalere.
- When weighted
by enrollment, a mere 9% of current PDP
enrollees are in contracts that will have 4 or more stars in 2023, down
from 42% in the 2022 plan year. By comparison, 72% of MA-PD enrollees are
currently in contracts that will have 4 or more stars in 2023, down from
90% of MA-PD members in 2022.
- While Star
Ratings for MA and MA-PD plans are a big deal, the same isn’t as true
for PDPs, remarks David Mike, who is also a Milliman principal and
consulting actuary.
- “There are two
things that cause PDP Star Ratings to be less of a focus, and one is the
lack of financial impact to revenue,” Mike tells AIS Health. Second,
PDPs are limited in their ability to engage members and thus influence
Star Ratings, Mike says. Because PDPs only cover drug benefits, they
can’t do as much to coordinate with members’ physicians and pursue other
innovative partnerships.
Diabetes adherence scores
declined, but categories didn’t
- In terms of
performance on individual measures, PDPs’ average Star Rating declined
for all four medication adherence measures. But the most notable drops
were for Medication Adherence for Diabetes Medications (plans averaged
3.9 stars in 2022 and 2.9 in 2023) and Medication Adherence for Hypertension
(3.5 average stars in 2022 versus 2.7 in 2023).
- “These aren’t
inconsistent with what we saw on the MA-PD side, so I don’t know if this
is sort of indicative of challenges on the adherence side coming off of
the pandemic,” remarks Kornfield.
- Looking at
PDPs’ average overall scores, the only medication adherence measure to
decline year over year was Medication Adherence for Diabetes
Medications. Kornfield speculates that the average Star Ratings for
individual measures don’t necessarily line up with overall measure
scores because CMS shifted the cut points that determine which scores
are needed to earn a certain rating.
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