Medication Management's Impact on Medicare Advantage Stars

This white paper discusses the evolving role of medication management within the Medicare Advantage (MA) Star Ratings program. It outlines a significant shift in focus from operational compliance to measurable clinical outcomes and member experiences. The paper details how medication management will increasingly influence Star Ratings performance and financial outcomes, emphasizing its importance for health plans. It highlights the proposed retirement of 12 measures by CMS for Star Years 2028 and 2029, indicating a move towards prioritizing clinical outcomes. The paper also explains the critical weight of medication adherence measures, which will return to triple weighting in MY2027, and the expansion of Medication Therapy Management (MTM) eligibility starting in 2025, which will increase the number of members that plans must support. Additionally, it addresses the growing importance of behavioral health performance and the need for strong coordination among healthcare providers, pharmacies, and patients to improve treatment continuity and outcomes. The document concludes with actionable steps for health plans to prepare for these changes.