By Samantha D’Onofrio, Director, Health Plan Market Lead
Medicare Advantage (MA) enrollment continues to climb. More than 35 million people are enrolled in MA as of February, marking an increase of 1.1 million enrollees since February 2025. Special Needs Plans (SNPs) drove the majority of this increase, accounting for 83% of MA growth over the past year.
With complex medical needs often come high-risk medication combinations that can lead to adverse drug events, hospitalizations and other unnecessary healthcare utilization. To evaluate medication combinations that heighten risk of harm, CMS will incorporate two Pharmacy Quality Alliance developed measures to the Star Ratings program beginning in 2027:
1. Concurrent Use of Opioids and Benzodiazepines (COB). These medications increase overdose risk, especially when taken in combination. COB looks at the percentage of members who concurrently take prescription opioids and benzodiazepines for 30 or more cumulative days based on prescription drug event (PDE) data.
2. Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (POLY-ACH). Anticholinergic medications are used to treat conditions like COPD and overactive bladder. Taking more than one of these meds increases risk of falls, confusion and cognitive decline, which can ultimately lead to hospitalizations. POLY-ACH measures the percentage of members who concurrently take two or more unique anticholinergic meds for at least 30 cumulative days according to PDE data.
Previously on the Display Page, each of these measures will be single weighted for the 2027 Star Ratings, based on performance from the 2025 Measurement Year. Continuously evaluating and improving measure performance will help optimize future outcomes.
Complex Populations Need More Comprehensive Care
Assessing the cumulative risk of a member’s medication routine is key to catching potentially harmful medication combinations. The problem is, traditional pharmacy models commonly focus on each prescription filled at a time, limiting comprehensive evaluation of concurrent medication risks and drug interactions.
Ongoing, high-touch medication management driven by clinically actionable insights close the gap, operationalizing medication safety reviews beyond one-to-one drug analysis for better results. This approach transforms pharmacy from a back-end function into an active extension of the care team. Key elements include:
- Technology-Enabled Risk Identification. Science-based technology helps clinical pharmacists perform more comprehensive medication reviews to identify risks associated with concurrent use of opioids and benzodiazepines, multiple anticholinergic medications in older adults, and other polypharmacy risks among complex populations.
- Regular Medication Reviews. For high-need members, medication routines can change often, so it’s important to check them regularly. Completing reviews at the start of care and on a monthly basis thereafter sets members up for continued success.
- Integrated Care Team Engagement. Identifying risk is just the start. Proactively delivering clear, evidence-based recommendations through established communication workflows helps care teams optimize medication routines. Prescriber engagement may also be complemented by coordination with case managers to support timely review, acceptance and implementation of clinical recommendations.
The Payoff for Health Plans
Proactively addressing COB and POLY-ACH measures can help plans impact clinical, quality and cost outcomes, including:
- Improved Medication Safety. People with multiple chronic conditions typically see several providers who may prescribe medications without full visibility into each patient’s med routine. This can unintentionally lead to high-risk medication combinations, leaving members vulnerable to dangers including unexpected side effects. More comprehensive pharmacy care helps decrease risk of harm, enhancing medication safety.
- Stronger Star Ratings Performance. With the inclusion of COB and POLY-ACH measures in Star Ratings, plans that continuously evaluate and act now will be better positioned to optimize future Star Ratings and revenue.
- Lower Total Cost of Care. If members are on the right medication routines, it helps keep them healthy, at home and out of the hospital, reducing unnecessary medical spend that contributes to total cost of care.
Proactive pharmacy care does more than just fill and dispense prescriptions. It transforms healthcare for people with complex medical needs and the health plans who support them. How your plan performs today can significantly impact the future.
Ready to strengthen medication safety for your most complex members? Learn more about how comprehensive, high-touch pharmacy can help solve your toughest medication challenges.
