What are Star Ratings and Why do they Matter When Choosing a PBM?

The true standard of an effective pharmacy benefit manager (PBM) is its ability to serve patients and plan sponsors and lower overall health care costs. This is especially relevant and important when it comes to administering Medicare Part D prescription drug plans.

But how do you know if your PBM is administering a well-performing plan and how do you compare their plan performance to other PBMs who may have similar offerings?

Medicare Star Ratings play a big role in helping you learn which plans perform best and more importantly, which plans perform well consistently over time.

What Are Star Ratings?

One of the ways Pharmacy Benefit Dimensions’ (PBD) work is measured against all the other PBMs across the country is through the Centers for Medicare and Medicaid Services (CMS) Star Ratings system. Initiated in 2007, the Star Ratings are used to assess the quality, value and performance of every Medicare plan throughout the nation.

 How Are Star Ratings Determined?

Every year, Medicare evaluates plans based on a 5-star rating system. Medicare star ratings help you know how good a job our plan is doing. You can use these star ratings to compare our plan's performance to other plans.

While Medicare designates an overall star rating to prescription drug plans annually, there are a variety of factors that play into how a plan is rated, including:

  • How our members rate our plan’s services and care
  • How well our doctors detect illnesses and keep members healthy
  • How well our plan helps our members use recommended and safe prescription medications    

4.5 Medicare Star Ratings for 2021

Pharmacy Benefit Dimensions earned a 4.5 out of 5 overall stars for its 2021 plan year Medicare Employer Group Waiver Plan (EGWP) Prescription Drug Plan (PDP) from the Centers for Medicare and Medicaid Services (CMS).* **

More specifically, ratings for pharmacy or drug plan services are based on the following measures:

  • Customer service: How well the drug plan handles member calls and appeals.
  • Complaints and Medicare audits: How often members filed complaints about the drug plan.
  • Member experience: Member satisfaction with the drug plan.
  • Drug pricing: How well the plan prices prescriptions.
  • Patient safety: How often members get prescriptions considered safer and clinically recommended for their condition(s).

Why Are Star Ratings Important?

A high star rating gives plans greater visibility, year-round enrollment opportunities and financial advantages that directly affect groups’ benefits and costs. It is important to note that every plan is evaluated against the same set of criteria, so you can objectively determine which plans are performing well versus those that are not. And while star ratings are a helpful way to get an overall sense for how a plan performs, keep in mind that plans are not a one-size-fits-all solution. It is important to factor in the various categories of a plan’s performance to best align your needs with the services provided by your PBM.

How Does PBD Compare to Other PBMs?

We earned a 4.5 rating out of 5 overall stars for our 2021 plan year Medicare Employer Group Waiver Plan (EGWP) Prescription Drug Plan (PDP) from CMS.

That score ranked us among the best in the country. The average overall star rating of all PDPs for the 2021 plan year was 3.58.

We have consistently earned high star ratings (4.0 or higher) since receiving a Medicare EGWP PDP contract in 2015, including being one of only four PDP contracts to receive a perfect 5-star rating in 2019.

What is a Medicare EGWP Prescription Drug Plan (PDP)?

EGWP PDPs are customized Medicare prescription drug plans developed exclusively for employer and union groups. Employer groups partner with a PBM that has contracted directly with a Medicare Part D plan sponsor. An EGWP PDP is not open to the individual market, but rather a specific plan only available for employers or union groups. Employers generally use EGWP PDPs to provide supplemental coverage for Medicare-eligible retirees and covered Medicare-eligible dependents beyond the standard benefits typically offered by other Medicare prescription drug plans.

What Sets PBD Apart from Other PBMs?

The star rating is one example of our commitment to excellence. We believe that each client is unique, and that pharmacy benefits should not be a “one-size-fits-all” solution. Our understanding of total cost coupled with our experience in managing prescription drug benefits, sets us apart. As a national URAC-accredited PBM, we deliver greater quality, better service and lower cost.

*Pharmacy Benefit Dimensions is a subsidiary of Independent Health. Independent Health is a PDP with a Medicare contract. Enrollment in Pharmacy Benefit Dimensions depends on contract renewal between Independent Health and CMS.

** Every year, Medicare evaluates plans based on a 5-star rating system.

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