Epic RX

Start 2023 Strong Knowing These Star Ratings Changes

The COVID-19 pandemic shifted the way the world views health care. In response, the Center for Medicare & Medicaid Services (CMS) has adopted several changes to the idea that patients should face minimal hurdles to receiving care and treatment during COVID-19.

New & Notable in 2023

The following measures have distinct exclusions that indicate how the measurements were conducted.

Medication Adherence Measures

For MAPD thresholds, all thresholds see an increase across all measures.

For PDP thresholds, all thresholds see an increase as well.

For pharmacies: The medication adherence measures the percentage of eligible members with a proportion of days covered (PDC) rate of 80% or over for the specific drug classes (e.g., diabetes, hypertension, and cholesterol medications).

Statin Use in Persons with Diabetes (SUPD)

The average performance for the SUPD measure was up 2% for MAPD, to a new average of 83%, and 3% for PDPs, to a new average of 81%.

For pharmacies: The SUPD measures the percentage of beneficiaries 40-75 years old who were dispensed at least two diabetes medications during the measurement period. Exclusions include members with Early State Renal Disease (ESRD).

Statin Therapy for Patients with Cardiovascular Disease (SPC) – Part C

The average performance for the SPC measure was up 3% to 84%.

For pharmacies: The percentage of males 21–75 years of age and females 40–75 years of age during the measurement year identified as having clinical atherosclerotic cardiovascular disease (ASCVD) and who were dispensed at least one high or moderate-intensity statin medication during the measurement year. Several exclusions exist with other conditions including ESRD and Hospice.

MTM Program Completion Rate for Comprehensive Medication Review (CMR)

In addition to the increase in measure-level Star Ratings, the measure averages also increased significantly with MAPDs now having an average score of 83%, up 7% from the year prior, and PDPs have an average score of 54%, which is an increase of 9%.

For pharmacies: This measures the percent of MTM eligible members that received a CMR during the measurement period of at least 61 days or more of continuous enrollment. However, members that did not receive a CMR during the same period would be excluded from the measure.

What Should I Do?

You can view more information and an organized look at MAPD and PDP thresholds here.

The Clinical Performance Dashboard was developed exclusively for EPIC Pharmacy Network, Inc. (EPN) members. It is designed to provide pharmacies quick and easy access to essential performance information. Pharmacies can view their performance at a glance for PrescribeWellness, EQuIPP, OutcomesMTM, and Mirixa; and, most importantly, are provided support on how to improve.

Interested in learning more about this exciting performance tool or viewing a demo? Contact the EPIC Rx Clinical Programs Team online or at 800-965-EPIC (3742).