25 Medicare contracts earn quality bonuses

The 2023 Star ratings were recently released by the Centers for Medicare & Medicaid Services (CMS). Twenty five Prime-supported Medicare contracts earned 4 Stars or more in the ratings released by CMS. This makes them eligible to receive a quality bonus payment.

“These results highlight how Prime works to make health care more affordable for members,” says Kip Haffner, vice president, government programs. “The payments are worth hundreds of millions of dollars to our health plan clients to help them better serve their members.”

These results mean that 73% of our Medicare Advantage Prescription Drug (MAPD) members are covered by a plan with an overall rating of 4 or more Stars.

Stars and total drug management

Star ratings have 40 measures that combine for one rating:

• Part C measures mostly the health plan and medical benefit
• Part D measures the drug benefit

As a pharmacy benefit manager, Prime influences many of the Part D measures reflecting:

• Operations
• Customer experience
• Medication adherence

Continuous improvement

CMS evaluates performance data each year and may adjust the measures for all metrics. This makes it more challenging to earn higher Star ratings.

“We have a strong foundation,” explains Kip Haffner. “Our adherence programs are clinically sound and validated by research. Our operations are becoming industry-leading. We build on these strengths every year. CMS can raise the bar, and here at Prime, we’ll keep innovating,” he said.

Prime continues to innovate with our Blue Plan clients providing products and services that deliver improved quality to members.

Take a look at some of the award-winning research behind these products. SmartAdherence™ Missed Refill Program, lower cost share generics and Quality-Based Network. And you’ll see how Prime is helping to make health care work better.