Dec. 4, 2024
In January 2025 the Centers for Medicare & Medicaid Services is adding two quality measures to its Star Ratings for Medicare prescription drug plans. These measures track potentially high-risk combinations of medications and will impact 2027 Star Ratings.
Concurrent Use of Opioids and Benzodiazepines measures the percentage of Medicare Part D beneficiaries ages 18 years or older with concurrent use of opioids and benzodiazepines. Combining benzodiazepines and opioids presents serious health risks, including the risk of overdose death, according to CMS.
- CMS defines concurrent use as overlapping days’ supply for at least 30 cumulative days during the measurement period, which is the calendar year. CMS uses prescriptions’ date of service and days’ supply to determine concurrent use.
- Prescription claims may be for the same or different opioids.
- CMS excludes patients from this measure if they have cancer or sickle cell disease, are in hospice or receiving palliative care.
Polypharmacy Use of Multiple Anticholinergic Medications in Older Adults tracks the percentage of Medicare Part D beneficiaries ages 65 years or older with concurrent use of two or more unique anticholinergic medications during the measurement period. The use of multiple anticholinergic medications in older adults is associated with an increased risk of cognitive decline.
- Concurrent use is defined as overlapping days’ supply for at least 30 cumulative days during the measurement period.
- CMS excludes patients from this measure if they are in hospice care.
Here are samples of anticholinergic medications included in this measure. The list isn’t all-inclusive.
Class |
Anticholinergic medications |
Alternatives |
Antihistamine |
cyproheptadine, diphenhydramine, hydroxyzine, meclizine |
levocetirizine, azelastine nasal spray |
Antiparkinsonian |
benztropine, trihexyphenidyl |
amantadine, carbi/levodopa, entacapone |
Skeletal Muscle Relaxants |
cyclobenzaprine, orphenadrine |
methocarbamol, baclofen, tizanidine |
Antidepressants |
amitriptyline, clomipramine, desipramine, doxepin (>6mg/day), imipramine, nortriptyline, paroxetine |
bupropion, citalopram, fluoxetine, sertraline, escitalopram |
Antipsychotics |
chlorpromazine, clozapine, olanzapine, perphenazine, |
aripiprazole, quetiapine, risperidone, ziprasidone |
Antimuscarinics (Urinary Incontinence) |
fesoterodine, oxybutynin, solifenacin, tolterodine, trospium |
Myrbetriq, Gemtesa |
Antispasmodics |
clidinium-chlordiazepoxide, dicyclomine, scopolamine |
glycopyrrolate |
Antiemetics |
prochlorperazine, promethazine |
ondansetron |
About Star Ratings: CMS rates Medicare Part D and Medicare Advantage plans on a scale from one to five stars based on multiple quality and performance measures.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. The fact that a service or treatment is described in this material, is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.