Medication Management’s Role in Medicare Advantage Stars
CMS has proposed significant changes to the Medicare Advantage Star Ratings program, and medication management is at the center of what comes next. This white paper examines the proposed measure retirements, shifting clinical priorities, and the growing weight of adherence, MTM, and behavioral health performance. Whether you’re preparing for MY2027 or building a longer-term strategy, here’s what health plans need to know now.
A Guide to Medication Management for CMS Star Ratings
CMS Star Ratings, issued annually by the Centers for Medicare & Medicaid Services (CMS), serve as a benchmark for how well health plans deliver quality care and positive member experiences. Plans earning 4 or more stars are eligible for Quality Bonus Payments (QBPs), which increase their Medicare revenue and enable them to enhance benefits or reduce premiums for members.
Paxit vs Bingo Card Cost Savings
The studies and models referenced in the Actuarial Review conclude that the Paxit dispensing system will generate cost savings of approximately 11% (of total drug spend) versus the Bingo Card dispensing approach. In 2025 dollars, that is equivalent to at least $32 PMPM in savings for nursing home patients, who on average incur slightly less than $300 PMPM for drugs. The Paxit system uses a daily dosage dispersion approach, compared to traditional 30-day packaging with the Bingo cards.
The Pharmacy Leader’s Playbook
As a Pharmacy Leader, you’re steering pharmacy strategy beyond compliance, with a focus on improving adherence, outcomes, and plan performance. However, in a post-pandemic landscape of tighter competition and rising drug costs, reactive Medication Therapy Management (MTM) programs tend to fall short. Comprehensive Medication Management (CMM) is the proactive, clinical-first alternative—one that elevates pharmacists, boosts Star Ratings, and strengthens member retention.
