Pharmacy Quality Metrics and Star Ratings Explained

Quality Metrics in Pharmacy

Pharmacy quality metrics have become increasingly important as healthcare shifts toward value-based care. Understanding these measures is essential for pharmacy technicians who want to contribute to their pharmacy's performance and success.

CMS Star Ratings

The Centers for Medicare and Medicaid Services (CMS) uses a star rating system (1 to 5 stars) to evaluate Medicare Part D plans. Pharmacies directly influence several medication-related measures:

• Medication adherence for diabetes medications
• Medication adherence for hypertension (RAS antagonists)
• Medication adherence for cholesterol (statins)
• Statin use in persons with diabetes

Proportion of Days Covered (PDC)

PDC is the primary measure of medication adherence. It calculates the percentage of days a patient has medication available during a measurement period. A PDC of 80 percent or higher is considered adherent. Pharmacy technicians support PDC by:

• Identifying patients due for refills and conducting outreach
• Synchronizing medication fill dates through med sync programs
• Resolving insurance barriers that delay refills
• Enrolling patients in automatic refill programs

Other Quality Measures

• Generic dispensing rate tracks the percentage of prescriptions filled as generics
• Medication therapy management (MTM) completion rates
• Immunization administration rates
• Opioid safety measures including days supply limits and naloxone co-prescribing

Quality metrics knowledge sets you apart in the job market. Prepare for your PTCB exam with our comprehensive study resources and practice tests.