How is it possible the nation's pharmacies have a laser-like focus on a rating system that doesn't even apply to them?
It's possible when the rating system involved is the Medicare Part C and Part D Star Ratings. Pharmacy performance affects a significant percentage of a prescription drug plan's overall score. Thus, as plans consider which pharmacies to list as "preferred partners" for its beneficiaries, they will naturally want to steer patients to pharmacies that excel in ratings-related criteria.
The star ratings system was implemented in 2008 by the Centers for Medicare & Medicaid Services (CMS) as a way to measure quality and effectiveness of participating plans. Medicare Advantage (Part C) and prescription drug plans (Part D) are assessed each year and awarded a star rating between one and five, based on performance on specific measures.
Each year, CMS publishes the star ratings ranking, which allows patients to compare plan performance, and to incentivize each plan to improve its score. In addition, star ratings can be the basis for financial incentives for some plans and providers.
In 2020, approximately 52% of Medicare Advantage plans with prescription drug coverage earned 4 stars or higher. In terms of enrollment, CMS reports roughly 80% of MA-PD enrollees will be registered for plans with at least 4 stars.
Among stand-alone prescription drug plans active in 2020, approximately 30% have received at least 4 stars, accounting for coverage of about 28% of plan enrollees.
With pharmacy-performance tied to many of the rating criteria, a pharmacy committed to excelling in those particular areas would help plan managers increase their ratings.
Prescription drug considerations
Within these broad categories are several considerations that directly relate to pharmacy performance. These factors include:
According to analysis by McKesson, pharmacy-related measures are weighted heavily and can impact up to 50 percent of a Medicare plan’s overall star rating. It’s easy to see then, why plan administrators scrutinize pharmacy performance and only want to engage with high-performers.
Pharmacies can rely on their technology systems to satisfy pharmacy-related quality measurements. A comprehensive pharmacy management system, such as PrimeRx™, will offer capabilities that include:
While it's true that pharmacies are not specifically subject to the Five-Star Ratings System, it's also true that positioning itself as a "Five-Star Champion" can boost a pharmacy's appeal to plan managers.