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Understanding the 2017 CMS Star Ratings - Drug Safety and Accuracy of Drug Pricing
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.
This category shows how each plan performs in drug safety and the accuracy of their drug pricing. It includes how accurate the plan’s pricing information is and how often members with certain medical conditions are prescribed drugs in a way that is safer and clinically recommended for their condition.

This category is based on six (6) measures:



The drug safety and accuracy of drug pricing data comes from several sources, including the final Prescription Drug Event (PDE) data for calendar year 2015 submitted by drug plans to Medicare. PDE data summarize each beneficiary’s prescription drug fills under Medicare Part D, using CMS-defined standard fields and price files submitted by drug plans to Medicare for display on Medicare’s Plan Finder Website.

Additional data source information for each sub-category is outlined below.




Medicare.gov Plan Finder Drug Price Accuracy

Plan Provides Accurate Drug Pricing Information. A score comparing the prices members actually pay for their drugs to the drug prices the plan provided for the Medicare.gov Plan Finder Website). (Higher scores are better because they mean the plan provided more accurate prices.)

Data Source:
This measure looks at how well a plan does at providing accurate drug pricing for Medicare’s Plan Finder Website. Medicare gives the drug plan a score from 0 to 100. Higher scores are better because it means prices are more accurate. To measure price accuracy, the price files that plans submit for display on Medicare’s Plan Finder Website from 01/01/2015 - 09/30/2015 are compared to Prescription Drug Event (PDE) data from 01/01/2015 - 09/30/2015 that tell what members pay when they fill a prescription.

This measure has a weight of 1.0 when combined with other measures to calculate the summary ratings.




High Risk Medication

Plan members 65 and older who received prescriptions for certain drugs with a high risk of side effects, when there may be safer Drug choices. The percent of plan members who got prescriptions for certain drugs with a high risk of serious side effects, when there may be safer drug choices.

Data Source:
The information for this measure comes from Prescription Drug Event (PDE) data for calendar year 2015. Only final action PDE claims are used to calculate the patient safety measures. PDE adjustments made post-reconciliation were not reflected in this measure. The measure is limited to members over 65 years of age, and for those drugs identified to have high risk of serious side effects in patients over 65 years of age. Based on medical research showing some prescription drugs have serious side effects for people 65 and older, doctors and plans share a responsibility for providing safe prescription drugs.

This measure has a weight of 3.0 when combined with other measures to calculate the summary ratings.




Medication Adherence for Diabetes Medications

Taking diabetes medication as directed. One of the most important ways you can manage your health is by taking your medication as directed. The plan, the doctor, and the member can work together to find ways to help the member take their medication as directed. Percent of plan members with a prescription for diabetes medication who fill their prescription often enough to cover 80% or more of the time they are supposed to be taking the medication. (“Diabetes medication” means a biguanide drug, a sulfonylurea drug, a thiazolidinedione drug, a DPP-IV inhibitor, an incretin mimetic drug, a meglitinide drug or a SGLT2 inhibitor. Plan members who take insulin are not included.)

Data Source:
The information for this measure comes from Prescription Drug Event (PDE) data for calendar year 2015. Only final action PDE claims are used to calculate the patient safety measures. PDE adjustments made post-reconciliation were not reflected in this measure. The measure is limited to members who received at least two prescriptions for an oral diabetes medication.

This measure has a weight of 3.0 when combined with other measures to calculate the summary ratings.




Medication Adherence for Hypertension (RAS antagonists)

Taking blood pressure medication as directed. One of the most important ways you can manage your health is by taking your medication as directed. The plan, the doctor, and the member can work together to find ways to help the member take their medication as directed. Percent of plan members with a prescription for a blood pressure medication who fill their prescription often enough to cover 80% or more of the time they are supposed to be taking the medication. (“Blood pressure medication” means an ACE (angiotensin converting enzyme) inhibitor, an ARB (angiotensin receptor blocker), or a direct renin inhibitor drug.)

Data Source:
The information for this measure comes from Prescription Drug Event (PDE) data for calendar year 2015. Only final action PDE claims are used to calculate the patient safety measures. PDE adjustments made post-reconciliation were not reflected in this measure. The measure is limited to members who received at least two prescriptions for a blood pressure medication.

This measure has a weight of 3.0 when combined with other measures to calculate the summary ratings.




Medication Adherence for Cholesterol (Statins)

Taking cholesterol medication as directed. One of the most important ways you can manage your health is by taking your medication as directed. The plan, the doctor, and the member can work together to find ways to help the member take their medication as directed. Percent of plan members with a prescription for a cholesterol medication (a statin drug) who fill their prescription often enough to cover 80% or more of the time they are supposed to be taking the medication.

Data Source:
The information for this measure comes from Prescription Drug Event (PDE) data for calendar year 2015. PDE adjustments made post-reconciliation were not reflected in this measure. The measure is limited to members who received at least two prescriptions for a statin cholesterol drug.

This measure has a weight of 3.0 when combined with other measures to calculate the summary ratings.




MTM Program Completion Rate for CMR

Members who dad a pharmacist (or other health professional) help them understand and manage their medications. Some members of the plan are in a program (called a “medication therapy management program”) to help them manage their drugs. The topic shows how many members in the program had an assessment of their medications from the plan. The assessment includes a discussion between the member and a pharmacist (or other health care professional) about all of the member’s medications. The member also receives a written summary of the discussion, including an action plan that recommends what the member can do to better understand and use his or her medications. Note: If you would like more information about the plan’s medication therapy management program, including whether you might be eligible for the program: Return to Star Ratings information page, scroll up to the top of the page, and then click on the “Manage Drugs” tab.

Data Source:
Medicare drug plans reported these data for 2015. The results have been independently validated.

This measure has a weight of 1.0 when combined with other measures to calculate the summary ratings.


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