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PQS Summarizes CMS Calendar Year 2023 Advance Notice on Pharmacy/Medication-Related Updates

11 Feb

PQS Summarizes CMS Calendar Year 2023 Advance Notice on Pharmacy/Medication-Related Updates

PQS has summarized the Calendar Year 2023 Advance Notice as it pertains to pharmacy and medication-related updates, originally released on February 2, 2022. It is available for download using the button below. You can access the complete CMS publication, “Advance Notice of Methodological Changes for Calendar Year (CY) 2023 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies” HERE.

 

PQS CY2023 Advance Notice Summary

Why read the PQS Summary of the 2023 Advance Notice?

  • CMS utilizes data in arrears to understand proposed changes for the Star Ratings program as relevant to Medicare Part C and D. Therefore, the performance as calculated in 2021 will drive cut-points, thresholds, adjustments, and more for CY 2023.
  • Due to the nature of how the Star Ratings program utilizes data from prior years to inform future program design, it is imperative that Health Plans, PBMs and Pharmacies understand how performance will be evaluated and used for future years. Understanding the CMS’s guidelines and guardrails for the program and planning ahead may lead to further success in the program.

Inside our regulatory update, we provide a condensed high-level summary of measure-related updates, including patient experience/complaints and access, Part C changes of interest-Controlling Blood Pressure and Various Part D changes of interest. Download the PQS Summary of Pharmacy/Medication-Related Updates in the CY 2023 Advance Notice by clicking the button below.

PQS CY2023 Advance Notice Summary