Patient Engagement Center (PEC)

Star Ratings Updates 2018

The Center for Medicare and Medicaid Services (CMS) has issued new standards for their Star Ratings in 2018. PrescribeWellness has updated our measures for our Star Ratings to reflect these changes. Below we have listed all the changes to help you better understand your pharmacy’s Star Ratings.

  • We will no longer be tracking elderly patients on High Risk Medications (HRM). Previously, the PEC displayed this measure, but has been removed for 2018.
  • The PEC will continue to display Diabetic Patients on Statin. You will see that this measure still does not have any stars below it (illustrated below). Currently, CMS does not factor this into their Star Ratings, but they will begin using this measure in 2019. You can use this information to proactively speak with patients who could affect your ratings in the future.

Star Rating Cut Points

Below we have listed the new cut points for CMS Star Ratings in 2018. The PEC displays the stricter measure between MAPD and PDP. For 2018, PDP is the strictest in all categories.

Diabetes Adherence

2 Stars: < 76% – 79.9%

3 Stars:    80% – 83.9%

4 Stars:    84% – 85.9%

5 Stars:    86% and higher

Hypertension Adherence

2 Stars: < 78% – 82.9%

3 Stars:    83% – 85.9%

4 Stars:    86% – 88.9%

5 Stars:    89% and higher

Cholesterol Adherence

2 Stars: < 73% – 78.9%

3 Stars:    79% – 81.9%

4 Stars:    82% – 85.9%

5 Stars:    86% and higher