Implement Pharmacy Performance Measures for Value-Based Care

The Pharmacy Quality Alliance (PQA) has a new pharmacy performance measure that evaluates adherence to medications for diabetes, renin angiotensin system antagonists for hypertension, and statins for high cholesterol through a single composite measure.¹ Although many might think the PQA already had member-endorsed adherence measures for these medications, the situation is a bit nuanced.

There are 3 similar PQA adherence measures used in the Medicare Part D Star Ratings that were developed, tested, and specified for health plan performance measurement.² There are notable differences between those health plan measures and the PQA’s new pharmacy measure. Endorsed by PQA members after rigorous development and testing, the new composite pharmacy adherence measure is a major step forward in the PQA’s work to develop standard pharmacy performance measures focused on improving patient care.

Addressing Pharmacy and Stakeholder Interests

This measure addresses 3 key interests expressed by pharmacy stakeholders, including some communicated by the National Association of Chain Drug Stores and the National Community Pharmacists Association to the Centers for Medicare & Medicaid Services.³ First, it measures the performance of individual pharmacies and provides a basis for evaluating and rewarding them for the patients under their care.

Second, the measure’s composite approach is important when evaluating pharmacies, many of which have small numbers of patients on certain medications. As endorsed and specified, each pharmacy must have at least 30 eligible patients to be reliably evaluated by this measure. This minimum number for reliability is easier to reach with the composite measure.

Third, this measure is aligned with the PQA health plan adherence measures used in the Medicare Part D Star Ratings program. Therefore, it should be considered as a solution to align incentives between health plans and pharmacies that are working together to improve adherence.

Multiple pharmacy stakeholders have told the PQA that the quality measures often used in their Part D agreements are health plan measures and do not accurately evaluate their contributions to adherence. This measure addresses that issue and provides an appropriate measure for individual pharmacy performance.

The PQA composite pharmacy performance measure was prioritized by its members and developed with input from a technical expert panel that included 6 health plan and 6 pharmacy representatives. It was then successfully tested for use in value-based plan-pharmacy agreements. The collaborative, consensus-based, transparent process has consistently produced high-quality measures that balance the needs of relevant industry stakeholders.

Now is the Time for Pharmacy Measures

Medication adherence continues to be an important part of evaluating and supporting high-value care. With the endorsement of this new pharmacy adherence measure, now is the time for pharmacies to advocate for its inclusion in agreements with health plans for 2023, which from an implementation standpoint is just around the corner.

The PQA also endorsed a specialty pharmacy turnaround time measure that evaluates the average number of days between a specialty pharmacy receiving a new prescription for a specialty medication and the prescription being ready for pickup or scheduled for delivery.

Work on New Measures Continues

The PQA is working to develop and pilot pharmacy measure concepts for control, improvement, and reporting of blood pressure and hemoglobin A_1C.⁴ The PQA also will begin work this year to develop a specialty pharmacy prescription abandonment rate measure.

Each of these pharmacy measures in development is aligned with pharmacy services that improve patient health outcomes. Collectively, they will form a set of standardized pharmacy performance measures that can be used across the care system.

Ultimately, the success of pharmacy measures depends on whether they are effectively used in the market. The composite adherence measure provides a timely opportunity for health plans and pharmacies to pursue shared goals in value-based care, while laying the groundwork for the implementation of future outcomes-focused measures that require time, relevant data sources, and testing to develop. From adherence to outcomes, the PQA will continue to provide tools that evaluate care, help close gaps, and improve patient health.

Micah Cost, PharmD, MS, is CEO of the Pharmacy Quality Alliance in Alexandria, Virginia.

References

1. PQA endorses pharmacy performance measures for medication adherence and specialty turnaround time. News release. Pharmacy Quality Alliance. December 20, 2021. Accessed February 2, 2022. https://www.pqaalliance.org/pqa-endorses-pharmacy-performance-measures-for-medication-adherence-and-specialty-turnaround-time

2. PQA measure use in CMS’ Part D quality programs. Pharmacy Quality Alliance. Accessed February 2, 2022. https://www. pqaalliance.org/medicare-part-d

3. NCPA and NACDS discuss drug pricing with HHS officials. Indiana Pharmacists Association. August 3, 2018. Accessed February 2, 2022. https://www.indianapharmacists.org/news/ community-pharmacy-recommendations-for-measuring-quality-in-the-medicare-part-d-program/

4. PQA pharmacy performance measures in development. Pharmacy Quality Alliance. Accessed February 2, 2022. https://www. pqaalliance.org/pharmacy-measures#:~:text=Pharmacy%20performance%20measures%20evaluate%20quality,quality%2C%20 patient%2Dcentered%20care