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Understanding the 2019 CMS Star Ratings - Drug Safety and Accuracy of Drug Pricing

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 2017 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 01/01/2017 – 09/30/2017 are compared to Prescription Drug Event (PDE) data 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.



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 2017. 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 2017. 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 2017. 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 2017. The results have been independently validated.

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



Statin Use in Persons with Diabetes

The Plan Makes Sure Members with Diabetes Take the Most Effective Drugs to Treat High Cholesterol To lower their risk of developing heart disease, most people with diabetes should take cholesterol medication. This rating is based on the percent of plan members with diabetes who take the most effective cholesterol-lowering drugs. Plans can help make sure their members get these prescriptions filled.

Data Source:
Medicare drug plans reported these data for 2017. The results have been independently validated.


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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
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  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.